SUMMERVILLE 15 LLC NPI 1790012482

NPI Information

NPI: 1790012482
Provider Name: SUMMERVILLE 15, LLC

Doing Business As: BROOKDALE WEST BOYNTON BEACH

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

Address:
8220 JOG RD
BOYNTON BEACH, FL
ZIP 33472
Phone: (561) 733-3200
Get Directions

SUMMERVILLE 15, LLC is an assisted living facility in Boynton Beach, 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 15, LLC NPI is 1790012482. The provider is registered as an organization entity type.
The provider Is Doing Business As Brookdale West Boynton Beach.

The provider's business location address is:

8220 JOG RD
BOYNTON BEACH, FL
ZIP 33472-938
Phone: (561) 733-3200

The provider's authorized official is Bryan 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 10D0964802 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/17/2009 and was last updated on 5/13/2016.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		AL9384	FLORIDA	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0118960-00	MEDICAID	FLORIDA

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: 11/14/2023

NPI Synchronization or Removal

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