Healthcare Provider Details

I. General information

NPI: 1023407046
Provider Name (Legal Business Name): SENIOR LIVING III SRQ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 PHILLIPPI SHORES DR
SARASOTA FL
34231-3205
US

IV. Provider business mailing address

4301 ANCHOR PLAZA PKWY STE 400
TAMPA FL
33634-7529
US

V. Phone/Fax

Practice location:
  • Phone: 941-404-7888
  • 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 Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL12463
License Number StateFL

VIII. Authorized Official

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