Healthcare Provider Details

I. General information

NPI: 1336576321
Provider Name (Legal Business Name): SENIOR LIVING I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7179 40TH AVE N
SAINT PETERSBURG FL
33709-4560
US

IV. Provider business mailing address

4301 ANCHOR PLAZA PKWY STE 300
TAMPA FL
33634-7521
US

V. Phone/Fax

Practice location:
  • Phone: 727-490-3233
  • Fax:
Mailing address:
  • Phone: 813-330-2660
  • Fax: 844-808-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number12224
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: BILLIE ABREU
Title or Position: RISK MGMT & COMPLIANCE MANAGER
Credential:
Phone: 813-330-2660