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General NPI Number Information
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NPI Number | 1407293301
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Entity Type | Organization
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Legal Business Name | VANDERBILT BEACH ASSISTED LIVING FACILITY,LLC
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Dates
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Enumeration Date | 05/31/2013
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Last Update Date | 05/31/2013
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Provider Practice Location Address
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Address Line | 517 100TH AVE N
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City | NAPLES
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State | FL
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Zip | 34108-2235
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Country | US
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Telephone | 239-597-5177
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Fax | 239-514-7253
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Provider Business Mailing Address
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Address Line | 517 100TH AVE N
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City | NAPLES
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State | FL
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Zip | 34108-2235
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Country | US
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Telephone | 239-597-5177
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Fax | 239-514-7253
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. SANDRA LYNN MEDRANO
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Credential | LPN
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Telephone | 239-910-2283
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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 | AL5582
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License Number State | FL
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