Basic Information
| Provider Information | |||||||||
| NPI: | 1548443666 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PERPETUAL CARE & SENIOR LIVING SERVICES INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | TENDER LOVING CARE RETIREMENT RESIDENCE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 747 BON AIR ST | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338054631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636881196 | ||||||||
| FaxNumber: | 8636877707 | ||||||||
| Practice Location | |||||||||
| Address1: | 747 BON AIR ST | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338054631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636881196 | ||||||||
| FaxNumber: | 8636877707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2007 | ||||||||
| LastUpdateDate: | 12/12/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GASMENA | ||||||||
| AuthorizedOfficialFirstName: | PIER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8635957353 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | AL# 1047 | FL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.