Basic Information
| Provider Information | |||||||||
| NPI: | 1174733653 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMERVILLE SENIOR LIVING LLC | ||||||||
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| OtherOrganizationName: | SUMMERVILLE AT OVIEDO LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 EXECUTIVE PKWY | ||||||||
| Address2: | SUITE 530 | ||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945834255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258661999 | ||||||||
| FaxNumber: | 9258668468 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 PINE BARK POINT | ||||||||
| Address2: | |||||||||
| City: | OVIEDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079775250 | ||||||||
| FaxNumber: | 4079777122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DE LA CERDA | ||||||||
| AuthorizedOfficialFirstName: | ANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF LICENSING | ||||||||
| AuthorizedOfficialTelephone: | 9258661999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | AL9525 | FL | X | Nursing & Custodial Care Facilities | Assisted Living Facility | 311500000X | AL9525 | FL | X | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) |
No ID Information.