MEDICARE: SENIOR LIVING PROPERTIES IV, 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	305S00000X	Point of Service	AL9308	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	:	1659613750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR LIVING PROPERTIES IV, LLC

Provider Business Mailing Address
First Line	:	4611 JOHNSON RD
Second Line	:	SUITE 1
City	:	COCONUT CREEK
State	:	FL
Zip	:	33073-4361
Country	:	US
Telephone Number	:	954-691-1030
Fax Number	:	954-691-1036

Provider Business Practice Location Address
First Line	:	395 ALAFAYA WOODS BLVD
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-7095
Country	:	US
Telephone Number	:	407-977-8786
Fax Number	:	407-977-1033

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. URI RUBIN
Credential	:
Telephone Number	:	954-691-1030

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	03/27/2013

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