Crown Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

CROWN ASSISTED LIVING LLC

Doing business as

Crown Assisted Living LLC

Practice address

301 Milford PL
New Smyrna Beach, FL 32168-6826

Phone

(386) 409-7993

Fax

(386) 409-7993

NPI assigned

Jun 17, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Juris Bergs

Title

Administrator

Phone

(386) 333-2434

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Crown Assisted Living LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655424000000",
    "number": "1013648468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 MILFORD PL",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321686826",
            "telephone_number": "386-409-7993",
            "fax_number": "386-409-7993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MILFORD PL",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321686826",
            "telephone_number": "386-409-7993",
            "fax_number": "386-409-7993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROWN ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-17",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A",
        "authorized_official_last_name": "BERGS",
        "authorized_official_first_name": "JURIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "386-333-2434",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AL",
            "identifier": "10584",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crown Assisted Living LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel H Crandall, MS
• Sharon Louise Crane
• Brittney Alexandra Crawford, PT, DPT
• Olivia Marie Crocker
• Sandra Scott Crosby
• Austin Culver
• Philip Blaine Dahlquist, DMD
• Elisa Irene Davidow-Carter, LMHC
• Keiauna J Davidson
• Davis Dermatology, PA

• Assisted Living Facility in New Smyrna Beach, FL
• Providers in New Smyrna Beach, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.