Provider Demographics
NPI:1598116600
Name:TARPON SPRINGS ASSISTED LIVING OF WALTON PLACE
Entity Type:Organization
Organization Name:TARPON SPRINGS ASSISTED LIVING OF WALTON PLACE
Other - Org Name:WALTON PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-919-4935
Mailing Address - Street 1:501 S WALTON AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-4729
Mailing Address - Country:US
Mailing Address - Phone:727-722-9600
Mailing Address - Fax:727-722-9601
Practice Address - Street 1:501 S WALTON AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4729
Practice Address - Country:US
Practice Address - Phone:727-722-9600
Practice Address - Fax:727-722-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12859310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility