MEDICARE: CORAL SPRINGS COUNTRY CLUB FOR SENIORS, INC.

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	AL10582	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	:	1932543782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAL SPRINGS COUNTRY CLUB FOR SENIORS, INC.

Provider Business Mailing Address
First Line	:	2903 NW 115TH TER
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3439
Country	:	US
Telephone Number	:	954-839-4791
Fax Number	:

Provider Business Practice Location Address
First Line	:	2903 NW 115TH TER
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3439
Country	:	US
Telephone Number	:	954-839-4791
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PETRINEA A MATTIS
Credential	:	MBA/HCM
Telephone Number	:	954-839-4791

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	04/23/2013

Similar Medicare Providers

1477870624 — KATHERINE GRANBERRY LPC
Practice Location Address:

385 CREEK RD
DRIPPING SPRINGS, TX
78620-3439

Practice Phone: 512-797-4860
Practice Fax:

1447476981 — DR. MICHAEL ALAN LEAKE D.C.
Practice Location Address:

4219 NW 21ST ST
CAPE CORAL, FL
33993-3439

Practice Phone: 412-260-6120
Practice Fax:

1164780474 — DR. ERIC LLOYD HARTER DC
Practice Location Address:

1611 SANTA BARBARA BLVD , 170
CAPE CORAL, FL
33991-3439

Practice Phone: 239-772-2266
Practice Fax: 239-772-1017

1861816548 — DR ERIC L HARTER LLC
Practice Location Address:

1611 SANTA BARBARA BLVD , SUITE 170
CAPE CORAL, FL
33991-3439

Practice Phone: 239-772-2266
Practice Fax: 239-772-1017

1477955052 — MICHAEL A LEAKE DC PC
Practice Location Address:

4219 NW 21ST ST
CAPE CORAL, FL
33993-3439

Practice Phone: 412-260-6120
Practice Fax: 412-291-1150

1437000932 — ALEXA DANIELA GONZALEZ
Practice Location Address:

3000 NW 101ST LN UNIT 202
CORAL SPRINGS, FL
33065-3930

Practice Phone: 561-408-1098
Practice Fax:

Directions to “CORAL SPRINGS COUNTRY CLUB FOR SENIORS, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.