Healthcare Provider Details

I. General information

NPI: 1891331427
Provider Name (Legal Business Name): BUBBSH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 BLARNEY ST
PORT CHARLOTTE FL
33954-3751
US

IV. Provider business mailing address

370 BLARNEY ST
PORT CHARLOTTE FL
33954-3751
US

V. Phone/Fax

Practice location:
  • Phone: 720-295-3488
  • Fax: 413-487-9013
Mailing address:
  • Phone: 720-295-3488
  • Fax: 413-487-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER DAVID BEERS
Title or Position: PARTNER IN ALF
Credential:
Phone: 941-628-0635