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SUMMERVILLE AT GOLDEN POND LLC NPI 1629287420


NPI Information

NPI: 1629287420
Provider Name: SUMMERVILLE AT GOLDEN POND, LLC

Doing Business As: BROOKDALE PALMA SOLA

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 10D0935756

Address:
450 67TH STREET NORTH
BRADENTON, FL
ZIP 34209
Phone: (941) 794-5657
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SUMMERVILLE AT GOLDEN POND, LLC is an assisted living facility in Bradenton, FL. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. SUMMERVILLE AT GOLDEN POND, LLC NPI is 1629287420. The provider is registered as an organization entity type.
The provider Is Doing Business As Brookdale Palma Sola.

The provider's business location address is:

450 67TH STREET NORTH
BRADENTON, FL
ZIP 34209
Phone: (941) 794-5657
Fax: (941) 798-3521

The provider's authorized official is Byran Richardson .
The authorized official title is Evp, Chief Admin. Officer and has the following contact phone number (615) 564-8131.

The CLIA number assigned to this NPI record is 10D0935756 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/21/2007 and was last updated on 6/13/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1310400000XAssisted Living FacilityNo
2310400000XAssisted Living FacilityAL4712FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1140353200MEDICAIDFLORIDA
206905137-00MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/15/2022

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.