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General NPI Number Information
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NPI Number | 1215335708
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Entity Type | Organization
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Legal Business Name | SUNSHINE GARDENS/ CRYSTAL RIVER LLC
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 311 NE 4TH AVE
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4222
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Country | US
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Telephone | 352-563-0235
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Fax | 352-563-0239
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Provider Business Mailing Address
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Address Line | 311 NE 4TH AVE
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4222
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Country | US
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Telephone | 352-563-0235
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Fax | 352-563-0239
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. CHRISTINE ERICK
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Credential |
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Telephone | 352-563-0239
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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 | AL12230
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License Number State | FL
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