Provider Demographics
NPI:1407280837
Name:SL PRESIDENTIAL, LLC
Entity Type:Organization
Organization Name:SL PRESIDENTIAL, LLC
Other - Org Name:PRESIDENTIAL PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-894-0059
Mailing Address - Street 1:3880 S CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8622
Mailing Address - Country:US
Mailing Address - Phone:954-894-0059
Mailing Address - Fax:954-894-1943
Practice Address - Street 1:3880 S CIRCLE DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8622
Practice Address - Country:US
Practice Address - Phone:954-894-0059
Practice Address - Fax:954-894-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9921310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility