MEDICARE: SHELL ISLE ASSISTED LIVING 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	:	1962292060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELL ISLE ASSISTED LIVING LLC

Provider Business Mailing Address
First Line	:	1536 TANGERINE ST
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3608
Country	:	US
Telephone Number	:	727-481-9005
Fax Number	:	727-378-5589

Provider Business Practice Location Address
First Line	:	9110 STAR TRL
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-2542
Country	:	US
Telephone Number	:	727-378-5588
Fax Number	:	727-378-5589

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ROY ANTHONY GATLIN
Credential	:
Telephone Number	:	727-481-9005

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	05/12/2025

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