Provider Demographics
NPI:1619500220
Name:ATRIUM GARDENS ALF, LLC
Entity Type:Organization
Organization Name:ATRIUM GARDENS ALF, LLC
Other - Org Name:ATRIUM GARDENS ALF, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-260-4006
Mailing Address - Street 1:11125 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-3613
Mailing Address - Country:US
Mailing Address - Phone:336-260-4006
Mailing Address - Fax:
Practice Address - Street 1:1513 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3315
Practice Address - Country:US
Practice Address - Phone:813-265-0844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility