Provider Demographics
NPI:1437659232
Name:HSRE-AHR BONITA SPRINGS TRS LLC
Entity Type:Organization
Organization Name:HSRE-AHR BONITA SPRINGS TRS LLC
Other - Org Name:AMERICAN HOUSE BONITA SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-301-4239
Mailing Address - Street 1:11400 LONGFELLOW LN
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-5963
Mailing Address - Country:US
Mailing Address - Phone:239-301-4239
Mailing Address - Fax:239-301-0613
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:2018-02-19
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12672310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility