Provider Demographics
NPI:1912927260
Name:FLORIDA SENIOR LIVING, LLC
Entity type:Organization
Organization Name:FLORIDA SENIOR LIVING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-584-6755
Mailing Address - Street 1:114 STUART RD NE # 305
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4803
Mailing Address - Country:US
Mailing Address - Phone:423-584-6755
Mailing Address - Fax:
Practice Address - Street 1:1570 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7958
Practice Address - Country:US
Practice Address - Phone:863-385-6353
Practice Address - Fax:863-385-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHH19965007OtherSTATE LICENSE
FL108305Medicare Oscar/Certification