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NPI Code Detail

MEDICARE: FT MYERS ALF BSLC LLC

MEDICARE: FT MYERS ALF BSLC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living FacilityAL5096FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AL5096OTHERFLAHCA

General Provider Information

NPI Number : 1184073363
Entity Type Code : Organization
Provider Name (Legal Business Name) : FT MYERS ALF BSLC LLC
Provider Business Mailing Address
First Line : 1896 PARK MEADOWS DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-3738
Country : US
Telephone Number : 239-939-5421
Fax Number :
Provider Business Practice Location Address
First Line : 1896 PARK MEADOWS DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-3738
Country : US
Telephone Number : 239-939-5421
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : LIZA ROJAS
Credential :
Telephone Number : 941-809-6147
Provider Enumeration Date : 06/08/2016
Last Update Date : 06/08/2016

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Directions to “FT MYERS ALF BSLC LLC ” Practice Location

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