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General NPI Number Information
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NPI Number | 1215475017
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Entity Type | Organization
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Legal Business Name | FT. WHITE ALF BSLC LLC
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 6873 SW US HIGHWAY 27
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City | FORT WHITE
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State | FL
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Zip | 32038-3539
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Country | US
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Telephone | 941-809-6147
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Fax |
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Provider Business Mailing Address
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Address Line | 11611 WATER POPPY TER
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-5127
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Country | US
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Telephone | 941-809-6147
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LIZA ROJAS
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Credential |
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Telephone | 941-809-6147
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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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