Provider Demographics
NPI:1962292060
Name:SHELL ISLE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:SHELL ISLE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-481-9005
Mailing Address - Street 1:1536 TANGERINE ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3608
Mailing Address - Country:US
Mailing Address - Phone:727-481-9005
Mailing Address - Fax:727-378-5589
Practice Address - Street 1:9110 STAR TRL
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-2542
Practice Address - Country:US
Practice Address - Phone:727-378-5588
Practice Address - Fax:727-378-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility