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General NPI Number Information
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NPI Number | 1194140509
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Entity Type | Organization
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Legal Business Name | SENIOR LIFE LLC
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 619 ORANGE AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4786
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Country | US
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Telephone | 813-319-0961
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 48857
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City | TAMPA
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State | FL
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Zip | 33646-0124
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Country | US
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Telephone | 813-319-0961
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Fax |
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Authorized Official
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Title or Position | SENIOR ADMINISTRATOR
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Name | MR. CHARLES W CHERRY II
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Credential | J.D., M.B.A.
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Telephone | 813-267-7342
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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 | FL
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