MEDICARE: SAINT CYRIL THE GREAT 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	13030	FL

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

General Provider Information

NPI Number	:	1639692486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT CYRIL THE GREAT LLC

Provider Business Mailing Address
First Line	:	4580 SW 33RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5504
Country	:	US
Telephone Number	:	954-647-8859
Fax Number	:

Provider Business Practice Location Address
First Line	:	4580 SW 33RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5504
Country	:	US
Telephone Number	:	954-647-8859
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DAVID GUIRGUIS
Credential	:
Telephone Number	:	954-647-8859

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	07/24/2017

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Directions to “SAINT CYRIL THE GREAT LLC ” Practice Location

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