MEDICARE: SH CARROLLWOOD, 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
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9134	OTHER	FL	ALF LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194362491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SH CARROLLWOOD, LLC

Provider Business Mailing Address
First Line	:	2573 BARRINGTON CIR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-6805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13550 S VILLAGE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-8420
Country	:	US
Telephone Number	:	813-908-5300
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	SETH WALKER
Credential	:
Telephone Number	:	850-583-7990

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	02/26/2020

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Directions to “SH CARROLLWOOD, LLC ” Practice Location

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