Provider Demographics
NPI:1457611428
Name:SUMMERVILLE HOMES INC.
Entity Type:Organization
Organization Name:SUMMERVILLE HOMES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORREL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WINT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-961-9998
Mailing Address - Street 1:7933 INDIGO STREET
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5840
Mailing Address - Country:US
Mailing Address - Phone:954-961-9998
Mailing Address - Fax:954-951-9887
Practice Address - Street 1:7933 INDIGO STREET
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5840
Practice Address - Country:US
Practice Address - Phone:954-961-9998
Practice Address - Fax:954-951-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11016310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003496000Medicaid