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SUMMERVILLE AT PORT ORANGE, INC.

Alzheimer Center

Port Orange, Florida

Provider NPI: 1750545158

Organization Information:
Organization Name:  SUMMERVILLE AT PORT ORANGE, INC.


Practice Location:
1675 DUNLAWTON AVE  PORT ORANGE, FL 32127 US
Tel: 386-761-1055  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N311500000XNursing & Custodial Care Facilities
Alzheimer Center (Dementia Center)
Y310400000XNursing & Custodial Care Facilities
Assisted Living Facility
FLAL9792

Other Provider Identifiers:

IssuerNumberStateType
0111336-00FL05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




ALZHEIMERS JOBS FL - Page 1



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