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General NPI Number Information
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NPI Number | 1831134535
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Entity Type | Organization
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Legal Business Name | FSQ THE PALMS AT FORT MYERS LLC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 2674 WINKLER AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-9361
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Country | US
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Telephone | 239-275-7800
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Fax | 239-275-2023
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Provider Business Mailing Address
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Address Line | 255 WASHINGTON ST STE 270
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City | NEWTON
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State | MA
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Zip | 02458-1634
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Country | US
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Telephone | 617-796-8387
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Fax | 617-796-8385
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Authorized Official
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Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
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Name | JEFFREY C. LEER
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Credential |
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Telephone | 617-796-8387
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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 | AL7269
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License Number State | FL
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