Provider Demographics
NPI:1831134535
Name:FSQ THE PALMS AT FORT MYERS LLC
Entity Type:Organization
Organization Name:FSQ THE PALMS AT FORT MYERS LLC
Other - Org Name:THE PALMS AT FORT MYERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8387
Mailing Address - Street 1:255 WASHINGTON ST STE 270
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1634
Mailing Address - Country:US
Mailing Address - Phone:617-796-8387
Mailing Address - Fax:617-796-8385
Practice Address - Street 1:2674 WINKLER AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9361
Practice Address - Country:US
Practice Address - Phone:239-275-7800
Practice Address - Fax:239-275-2023
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FSQ THE PALMS AT FORT MYERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-17
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7269310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility