Provider Demographics
NPI:1326433020
Name:A SUMMERVILLE HOMES ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:A SUMMERVILLE HOMES ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR-VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORREL
Authorized Official - Middle Name:ALBERTA
Authorized Official - Last Name:WINT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-589-1632
Mailing Address - Street 1:7933 INDIGO STREET
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023
Mailing Address - Country:US
Mailing Address - Phone:954-589-1632
Mailing Address - Fax:954-589-1334
Practice Address - Street 1:2440 SW 82 TERRACE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025
Practice Address - Country:US
Practice Address - Phone:954-589-1632
Practice Address - Fax:954-589-1334
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMERVILLE HOMES CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12616310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility