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General NPI Number Information
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NPI Number | 1326433020
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Entity Type | Organization
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Legal Business Name | A SUMMERVILLE HOMES ASSISTED LIVING LLC
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 2440 SW 82 TERRACE
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City | MIRAMAR
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State | FL
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Zip | 33025
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Country | US
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Telephone | 954-589-1632
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Fax | 954-589-1334
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Provider Business Mailing Address
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Address Line | 7933 INDIGO STREET
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City | MIRAMAR
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State | FL
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Zip | 33023
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Country | US
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Telephone | 954-589-1632
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Fax | 954-589-1334
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Authorized Official
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Title or Position | ADMINISTRATOR-VP
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Name | MRS. CORREL ALBERTA WINT
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Credential |
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Telephone | 954-589-1632
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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 | AL12616
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License Number State | FL
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