1871061655 NPI number — SEACOAST AT SUMMERS POINTE LLC

Table of content: (NPI 1871061655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871061655 NPI number — SEACOAST AT SUMMERS POINTE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEACOAST AT SUMMERS POINTE 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:
Provider Other Organization Name Type Code:
6
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:
1871061655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1868 HIGHLAND OAKS BLVD
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
LUTZ
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-341-2712
Provider Business Mailing Address Fax Number:
815-935-1992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SUNSET DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47394-9251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-341-2712
Provider Business Practice Location Address Fax Number:
765-584-7496
Provider Enumeration Date:
11/09/2018

Additional Information

Authorized Official

Authorized Official Last Name:
FLORES
Authorized Official First Name:
MARC
Authorized Official Middle Name:
GERALD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-341-2712

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300072238 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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