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General NPI Number Information
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NPI Number | 1952937112
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Entity Type | Organization
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Legal Business Name | SILVER LAKE VILLAGE, INC
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 34601 RADIO RD
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City | LEESBURG
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State | FL
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Zip | 34788-3301
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Country | US
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Telephone | 503-833-2814
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Fax |
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Provider Business Mailing Address
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Address Line | 33857 TERRAGONA DR
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City | SORRENTO
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State | FL
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Zip | 32776-6918
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Country | US
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Telephone | 503-833-2814
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMUEL BONGIOVANNI
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Credential |
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Telephone | 503-833-2814
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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 |
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License Number State |
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