Healthcare Provider Details

I. General information

NPI: 1811239239
Provider Name (Legal Business Name): SPRINGHILL GARDENS ASSISTED LIVING,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2013
Last Update Date: 03/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 GREYNOLDS AVE
SPRING HILL FL
34608-4221
US

IV. Provider business mailing address

3010 GREYNOLDS AVE
SPRING HILL FL
34608-4221
US

V. Phone/Fax

Practice location:
  • Phone: 352-346-6970
  • Fax: 352-556-2947
Mailing address:
  • Phone: 352-346-6970
  • Fax: 352-556-2947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL11658
License Number StateFL

VIII. Authorized Official

Name: MRS. ELSIE F. CANARY
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 352-346-6970