Provider Demographics
NPI:1912511924
Name:FOUR MILE COVE SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:FOUR MILE COVE SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-409-9252
Mailing Address - Street 1:3965 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5845
Mailing Address - Country:US
Mailing Address - Phone:317-409-9252
Mailing Address - Fax:317-863-1116
Practice Address - Street 1:1701 FOUR MILE COVE PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2404
Practice Address - Country:US
Practice Address - Phone:239-677-3969
Practice Address - Fax:239-673-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility