Provider Demographics
NPI:1427517762
Name:SPRINGFIELD GARDENS GROUP HOME
Entity type:Organization
Organization Name:SPRINGFIELD GARDENS GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-418-1588
Mailing Address - Street 1:588 SW RAY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2950
Mailing Address - Country:US
Mailing Address - Phone:772-418-1588
Mailing Address - Fax:772-871-9005
Practice Address - Street 1:443 SW HOMELAND RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6208
Practice Address - Country:US
Practice Address - Phone:772-418-1588
Practice Address - Fax:772-871-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility