SUMMERVILLE 3, LLC
Alzheimer Center
Lake Mary, Florida
Provider NPI: 1184834228
Organization Information:Organization Name: SUMMERVILLE 3, LLC
Practice Location:
150 MIDDLE STREET LAKE MARY, FL 32746 US
Tel: 407-321-7550 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
150 MIDDLE STREET LAKE MARY, FL 32746 US
Tel: 407-321-7550 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 311500000X | Nursing & Custodial Care Facilities Alzheimer Center (Dementia Center) | FL | AL10162 |
Y | 310400000X | Nursing & Custodial Care Facilities Assisted Living Facility | FL | AL10162 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
0089537-00 | FL | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin