Healthcare Provider Details

I. General information

NPI: 1114672995
Provider Name (Legal Business Name): CASALIA GARDEN ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2022
Last Update Date: 02/19/2022
Certification Date: 02/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13031 PARTRIDGE ST
SPRING HILL FL
34608-1300
US

IV. Provider business mailing address

13031 PARTRIDGE ST
SPRING HILL FL
34608-1300
US

V. Phone/Fax

Practice location:
  • Phone: 352-293-2630
  • Fax: 352-433-1077
Mailing address:
  • Phone: 352-293-2630
  • Fax: 352-433-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ALIA QURESHI
Title or Position: OWNER
Credential:
Phone: 813-300-1799