Provider Demographics
NPI:1285751370
Name:SOUTHERN GARDENS, LLC
Entity type:Organization
Organization Name:SOUTHERN GARDENS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:EARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-293-0072
Mailing Address - Street 1:255 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ALFRED
Mailing Address - State:FL
Mailing Address - Zip Code:33850-2133
Mailing Address - Country:US
Mailing Address - Phone:863-956-0411
Mailing Address - Fax:863-956-0164
Practice Address - Street 1:255 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE ALFRED
Practice Address - State:FL
Practice Address - Zip Code:33850-2133
Practice Address - Country:US
Practice Address - Phone:863-956-0411
Practice Address - Fax:863-956-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8937310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility