Provider Demographics
NPI:1952606519
Name:TITUSVILLE SENIOR LIVING PARTNERS, LLC
Entity Type:Organization
Organization Name:TITUSVILLE SENIOR LIVING PARTNERS, LLC
Other - Org Name:BENTON HOUSE OF TITUSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-383-2112
Mailing Address - Street 1:497 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2839
Mailing Address - Country:US
Mailing Address - Phone:321-383-2112
Mailing Address - Fax:
Practice Address - Street 1:497 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2839
Practice Address - Country:US
Practice Address - Phone:321-383-2112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11575310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL11575OtherACHA