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General NPI Number Information
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NPI Number | 1568083657
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Entity Type | Organization
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Legal Business Name | SUMMERHAVEN ASSISTED LIVING LLC
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Dates
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Enumeration Date | 04/30/2020
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Last Update Date | 04/30/2020
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Provider Practice Location Address
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Address Line | 520 LANYARD LN
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City | DEBARY
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State | FL
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Zip | 32713-2765
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Country | US
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Telephone | 386-668-3674
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Fax | 866-950-2951
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Provider Business Mailing Address
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Address Line | 2578 ENTERPRISE RD # 362
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City | ORANGE CITY
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State | FL
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Zip | 32763-7904
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Country | US
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Telephone | 386-668-3674
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Fax | 866-950-2951
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. GREGORY HOPCRAFT
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Credential |
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Telephone | 386-668-3674
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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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