Provider Demographics
NPI:1174280846
Name:MADISON AMERICAN BONITA SPRINGS TRS I, LLC
Entity Type:Organization
Organization Name:MADISON AMERICAN BONITA SPRINGS TRS I, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CORPORATE LICENSING
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-203-1800
Mailing Address - Street 1:1 TOWNE SQ STE 1600
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3728
Mailing Address - Country:US
Mailing Address - Phone:248-203-1800
Mailing Address - Fax:248-203-2929
Practice Address - Street 1:11400 LONGFELLOW LN
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-5963
Practice Address - Country:US
Practice Address - Phone:239-301-4239
Practice Address - Fax:239-301-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility