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General NPI Number Information
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NPI Number | 1730690538
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Entity Type | Organization
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Legal Business Name | CSL HAVERHILL SENIOR PROPERTIES, LLC
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 2939 S HAVERHILL RD
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City | HAVERHILL
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State | FL
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Zip | 33415-8118
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Country | US
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Telephone | 561-612-2415
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Fax |
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Provider Business Mailing Address
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Address Line | 1584 CHARLOTTE CIR
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City | NAPERVILLE
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State | IL
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Zip | 60564-8204
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Country | US
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Telephone | 312-401-2118
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEVEN BENNEMA
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Credential |
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Telephone | 312-401-2118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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