Healthcare Provider Details

I. General information

NPI: 1871336222
Provider Name (Legal Business Name): SNM COMPANION LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 CANTON PARK DR
WINTER HAVEN FL
33881-2751
US

IV. Provider business mailing address

631 TAFT DR
DAVENPORT FL
33837-3695
US

V. Phone/Fax

Practice location:
  • Phone: 863-275-4077
  • Fax:
Mailing address:
  • Phone: 863-275-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CALESIA DALTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 863-275-4077