Provider Demographics
NPI:1750756102
Name:SEMINOLE SENIOR LIVING
Entity type:Organization
Organization Name:SEMINOLE SENIOR LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ALF OPERSTIOND
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-919-4935
Mailing Address - Street 1:5901 US HIGHWAY 19
Mailing Address - Street 2:SUITE7
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2960
Mailing Address - Country:US
Mailing Address - Phone:727-623-9073
Mailing Address - Fax:727-623-9093
Practice Address - Street 1:9000 86TH AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-2641
Practice Address - Country:US
Practice Address - Phone:727-623-9073
Practice Address - Fax:727-623-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12103310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility