Provider Demographics
NPI:1649682865
Name:SUMMIT RETIREMENT LIFESTYLES C
Entity type:Organization
Organization Name:SUMMIT RETIREMENT LIFESTYLES C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:MAYONTE
Authorized Official - Last Name:ARGUILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-201-6999
Mailing Address - Street 1:100 HILLCREST HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7970
Mailing Address - Country:US
Mailing Address - Phone:904-201-6999
Mailing Address - Fax:
Practice Address - Street 1:100 HILLCREST HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-7970
Practice Address - Country:US
Practice Address - Phone:904-201-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLALF # 12250310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility