=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881414282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAVARRE GARDENS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2024
-----------------------------------------------------
Last Update Date | 10/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1709 SAROCO RD.
-----------------------------------------------------
City | GULF BREEZE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-684-3680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9218 NAVARRE PKWY
-----------------------------------------------------
City | NAVARRE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32566-2936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-939-7722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | ISAAC NEWLIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-939-7722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------