Provider Demographics
NPI:1336576321
Name:SENIOR LIVING I, LLC
Entity Type:Organization
Organization Name:SENIOR LIVING I, LLC
Other - Org Name:IVY RIDGE LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RISK MGMT & COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABREU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-330-2660
Mailing Address - Street 1:4301 ANCHOR PLAZA PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7521
Mailing Address - Country:US
Mailing Address - Phone:813-330-2660
Mailing Address - Fax:844-808-0071
Practice Address - Street 1:7179 40TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4560
Practice Address - Country:US
Practice Address - Phone:727-490-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALIDUS SENIOR LIVING REIT INVESTMENT MANAGEMENT CO., LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-04
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
FL12224311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)