Provider Demographics
NPI:1194183376
Name:SUMTER PLACE TRS LLC
Entity type:Organization
Organization Name:SUMTER PLACE TRS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:O
Authorized Official - Last Name:OETTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-674-3500
Mailing Address - Street 1:1550 KILLINGSWORTH WAY
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2175
Mailing Address - Country:US
Mailing Address - Phone:352-674-3500
Mailing Address - Fax:352-674-3512
Practice Address - Street 1:1550 KILLINGSWORTH WAY
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-2175
Practice Address - Country:US
Practice Address - Phone:352-674-3500
Practice Address - Fax:352-674-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9307261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015273300Medicaid