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General NPI Number Information
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NPI Number | 1801217914
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Entity Type | Organization
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Legal Business Name | ISLAND SPLENDOR ALF INC.
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Dates
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Enumeration Date | 12/17/2013
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 9057 109TH AVE
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City | SEMINOLE
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State | FL
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Zip | 33777-1115
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Country | US
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Telephone | 727-585-9788
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Fax | 727-204-6549
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Provider Business Mailing Address
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Address Line | 1155 18TH AVE SW
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City | LARGO
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State | FL
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Zip | 33778-1116
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Country | US
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Telephone | 727-585-9788
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Fax | 727-204-6549
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. ELSA JOHNSON
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Credential |
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Telephone | 727-585-9788
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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 | AL11915
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License Number State | FL
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