Healthcare Provider Details

I. General information

NPI: 1194183376
Provider Name (Legal Business Name): SUMTER PLACE TRS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 KILLINGSWORTH WAY
THE VILLAGES FL
32162-2175
US

IV. Provider business mailing address

1550 KILLINGSWORTH WAY
THE VILLAGES FL
32162-2175
US

V. Phone/Fax

Practice location:
  • Phone: 352-674-3500
  • Fax: 352-674-3512
Mailing address:
  • Phone: 352-674-3500
  • Fax: 352-674-3512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9307
License Number StateFL

VIII. Authorized Official

Name: SHEILA O OETTING
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-674-3500