MEDICARE: HUNTERS CREEK ALMC OP CO 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

General Provider Information

NPI Number	:	1740010040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTERS CREEK ALMC OP CO LLC

Provider Business Mailing Address
First Line	:	1701 BALL PARK RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-1135
Country	:	US
Telephone Number	:	407-900-2840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 BALL PARK RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-1135
Country	:	US
Telephone Number	:	407-900-2840
Fax Number	:	407-870-0288

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. SHIRAH RIOS
Credential	:
Telephone Number	:	407-900-2840

Provider Enumeration Date	:	08/02/2024
Last Update Date	:	08/02/2024

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