Provider Demographics
NPI:1285262584
Name:SEASONS GARDENS SENIOR RESIDENCE LLC
Entity type:Organization
Organization Name:SEASONS GARDENS SENIOR RESIDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:JED
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-284-7675
Mailing Address - Street 1:17250 SW 137TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-6405
Mailing Address - Country:US
Mailing Address - Phone:305-284-7675
Mailing Address - Fax:786-476-0134
Practice Address - Street 1:17250 SW 137TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-6405
Practice Address - Country:US
Practice Address - Phone:305-284-7675
Practice Address - Fax:786-476-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility