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NPI Code Detail

MEDICARE: SUMMERVILLE 16, LLC

MEDICARE: SUMMERVILLE 16, 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
1311500000XAlzheimer Center (Dementia Center)AL9294FL
2310400000XAssisted Living FacilityAL9294FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447427703
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUMMERVILLE 16, LLC
Provider Business Mailing Address
First Line : 6737 W WASHINGTON ST
Second Line : SUITE 2300
City : MILWAUKEE
State : WI
Zip : 53214-5647
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1700 NE INDIAN RIVER DR
Second Line :
City : JENSEN BEACH
State : FL
Zip : 34957-5853
Country : US
Telephone Number : 772-225-1355
Fax Number :
Authorized Official
Title or Position : EVP, CHIEF ADMIN. OFFICER
Name : BRYAN RICHARDSON
Credential :
Telephone Number : 615-564-8131
Provider Enumeration Date : 05/14/2008
Last Update Date : 05/13/2016

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Directions to “SUMMERVILLE 16, LLC ” Practice Location

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