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General NPI Number Information
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NPI Number | 1174280846
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Entity Type | Organization
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Legal Business Name | MADISON AMERICAN BONITA SPRINGS TRS I, LLC
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 11400 LONGFELLOW LN
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-5963
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Country | US
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Telephone | 239-301-4239
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Fax | 239-301-0613
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Provider Business Mailing Address
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Address Line | 1 TOWNE SQ STE 1600
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City | SOUTHFIELD
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State | MI
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Zip | 48076-3728
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Country | US
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Telephone | 248-203-1800
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Fax | 248-203-2929
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Authorized Official
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Title or Position | VP CORPORATE LICENSING
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Name | MS. SHEILA DARGA
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Credential |
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Telephone | 248-203-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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