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General NPI Number Information
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NPI Number | 1295387918
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Entity Type | Organization
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Legal Business Name | SOUTHERN PALM INC
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Dates
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Enumeration Date | 07/12/2019
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 1472 BOLGER AVE
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City | SPRING HILL
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State | FL
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Zip | 34609-6107
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Country | US
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Telephone | 352-600-8095
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Fax | 352-796-5262
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Provider Business Mailing Address
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Address Line | 1472 BOLGER AVE
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City | SPRING HILL
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State | FL
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Zip | 34609-6107
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Country | US
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Telephone | 352-600-8095
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Fax | 352-796-5262
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | MR. MATTHEW SUTERS
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Credential |
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Telephone | 850-559-2543
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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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