Provider Demographics
NPI:1083057459
Name:SOUTHWEST RETIREMENT HOME, INC.
Entity Type:Organization
Organization Name:SOUTHWEST RETIREMENT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-338-0252
Mailing Address - Street 1:3207 SW 42ND PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2624
Mailing Address - Country:US
Mailing Address - Phone:352-338-0252
Mailing Address - Fax:352-338-0252
Practice Address - Street 1:3207 SW 42ND PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-2624
Practice Address - Country:US
Practice Address - Phone:352-338-0252
Practice Address - Fax:352-338-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6688310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility