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General NPI Number Information
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NPI Number | 1710321112
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Entity Type | Organization
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Legal Business Name | NIC 4 SOUTHERN GARDENS LEASING LLC
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 255 E MAIN ST
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City | LAKE ALFRED
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State | FL
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Zip | 33850-2133
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Country | US
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Telephone | 212-479-5343
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Fax |
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Provider Business Mailing Address
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Address Line | 255 E MAIN ST
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City | LAKE ALFRED
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State | FL
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Zip | 33850-2133
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Country | US
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Telephone | 212-479-5343
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. BRIAN SIGMAN
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Credential |
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Telephone | 212-479-5343
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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 | 8937
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License Number State | FL
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