Provider Demographics
NPI:1154753911
Name:NORTHWOOD MANOR LLC
Entity type:Organization
Organization Name:NORTHWOOD MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ AMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHEREVE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:813-929-1656
Mailing Address - Street 1:27737 BREAKERS DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6685
Mailing Address - Country:US
Mailing Address - Phone:813-929-1656
Mailing Address - Fax:813-428-5164
Practice Address - Street 1:27737 BREAKERS DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6685
Practice Address - Country:US
Practice Address - Phone:813-929-1656
Practice Address - Fax:813-428-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-04
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11872310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility