=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962292060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHELL ISLE ASSISTED LIVING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2025
-----------------------------------------------------
Last Update Date | 05/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9110 STAR TRL
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34654-2542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-378-5588
-----------------------------------------------------
Fax | 727-378-5589
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1536 TANGERINE ST
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33756-3608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-481-9005
-----------------------------------------------------
Fax | 727-378-5589
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | ROY ANTHONY GATLIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-481-9005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------