Provider Demographics
NPI:1811239239
Name:SPRINGHILL GARDENS ASSISTED LIVING,LLC
Entity Type:Organization
Organization Name:SPRINGHILL GARDENS ASSISTED LIVING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CANARY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:352-346-6970
Mailing Address - Street 1:3010 GREYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-4221
Mailing Address - Country:US
Mailing Address - Phone:352-346-6970
Mailing Address - Fax:352-556-2947
Practice Address - Street 1:3010 GREYNOLDS AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-4221
Practice Address - Country:US
Practice Address - Phone:352-346-6970
Practice Address - Fax:352-556-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-24
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11658310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility