Basic Information
| Provider Information | |||||||||
| NPI: | 1598299414 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEWARD FLORIDA ALF LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 HUNTINGTON AVE | ||||||||
| Address2: | SUITE 1800 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021997610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174194700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 WUESTHOFF DR | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329406842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212556030 | ||||||||
| FaxNumber: | 3212553075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2017 | ||||||||
| LastUpdateDate: | 04/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | RICH | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6174194700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | AL8134 | FL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.