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General NPI Number Information
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NPI Number | 1932532942
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Entity Type | Organization
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Legal Business Name | EXTENDED CARE PORTFOLIO TENANT, LLC
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 9015 UNIVERSITY PKWY
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City | PENSACOLA
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State | FL
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Zip | 32514-5525
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Country | US
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Telephone | 850-477-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 13770 58TH ST N SUITE 312
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City | CLEARWATER
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State | FL
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Zip | 33760-3759
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Country | US
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Telephone | 727-726-3980
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MINDY MYERS
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Credential |
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Telephone | 727-726-3980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | AL9068
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License Number State | FL
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