Provider Demographics
NPI:1841902020
Name:GREAT AMERICAN ASSISTED LIVING COMMUNITY AT BRADENTON, LLC
Entity type:Organization
Organization Name:GREAT AMERICAN ASSISTED LIVING COMMUNITY AT BRADENTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LECOMTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-789-5896
Mailing Address - Street 1:12191 W LINEBAUGH AVE # 760
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 7TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-2103
Practice Address - Country:US
Practice Address - Phone:941-746-8108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility