1497965834 NPI number — SUMMERVILLE AT OCALA EAST, LLC

Table of content: (NPI 1497965834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497965834 NPI number — SUMMERVILLE AT OCALA EAST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMERVILLE AT OCALA EAST, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BROOKDALE PADDOCK HILLS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497965834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6737 W WASHINGTON ST STE 2300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53214-5650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-918-5000
Provider Business Mailing Address Fax Number:
925-866-8468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 SE 24TH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-622-9696
Provider Business Practice Location Address Fax Number:
352-622-3763
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP, CHIEF ADMIN. OFFICER
Authorized Official Telephone Number:
615-564-8131

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL7428 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 311500000X , with the licence number: AL7428 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0103574-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012433000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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