Healthcare Provider Details

I. General information

NPI: 1750981841
Provider Name (Legal Business Name): SENIOR LIVING PROPERTIES III, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3791 OLD CANOE CREEK RD
SAINT CLOUD FL
34769-6630
US

IV. Provider business mailing address

4611 JOHNSON RD UNIT 1
COCONUT CREEK FL
33073-4361
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-8502
  • Fax:
Mailing address:
  • Phone: 954-691-1030
  • Fax: 954-691-1036

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: STEPHANIE TUCKER
Title or Position: BILLING SPECIALIST
Credential:
Phone: 954-691-1030