Provider Demographics
NPI:1710181649
Name:2626 GOODLETTE ROAD ASSOCIATES
Entity Type:Organization
Organization Name:2626 GOODLETTE ROAD ASSOCIATES
Other - Org Name:WINDSOR PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-963-3400
Mailing Address - Street 1:2626 GOODLETTE RD N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4526
Mailing Address - Country:US
Mailing Address - Phone:239-403-0826
Mailing Address - Fax:239-403-8578
Practice Address - Street 1:2626 GOODLETTE RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4526
Practice Address - Country:US
Practice Address - Phone:239-403-0826
Practice Address - Fax:239-403-8578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLALF8972310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility