Basic Information
| Provider Information | |||||||||
| NPI: | 1083992200 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SENIOR LIVING PROPERTIES LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTHERLAND PLACE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3073 HORSESHOE DR SOUTH | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341046145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399633400 | ||||||||
| FaxNumber: | 2399633410 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 WINNERS CIR S | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152219001 | ||||||||
| FaxNumber: | 6152210081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2011 | ||||||||
| LastUpdateDate: | 07/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | FORD | ||||||||
| AuthorizedOfficialFirstName: | DORENE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF MIS | ||||||||
| AuthorizedOfficialTelephone: | 2399633400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | ACL0000000300 | TN | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.