Sri of Brandon MC, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

9739 Issued in FL

Legal business name

SRI OF BRANDON MC, LLC

Practice address

1819 Providence Ridge Blvd
Brandon, FL 33511-1899

Phone

(813) 657-8587

NPI assigned

Dec 23, 2013

Organization subpart

Yes

Parent organization

SUPERIOR RESIDENCES, INCAs reported in NPPES

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

Authorized official

Name

Dennis McCarthy

Title

Cio

Phone

(352) 686-3831

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Superior Residences of Brandon Doing business as

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

{
    "created_epoch": "1387756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387756800000",
    "number": "1184045890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1819 PROVIDENCE RIDGE BLVD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335111899",
            "telephone_number": "813-657-8587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1819 PROVIDENCE RIDGE BLVD",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335111899",
            "telephone_number": "813-657-8587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRI OF BRANDON MC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUPERIOR RESIDENCES, INC",
        "enumeration_date": "2013-12-23",
        "last_updated": "2013-12-23",
        "status": "A",
        "authorized_official_last_name": "MCCARTHY",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "CIO",
        "authorized_official_telephone_number": "352-686-3831"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "9739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA",
            "identifier": "9739",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Superior Residences of Brandon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sports and Orthopedic Rehabilitation Services Inc
• Randall Israel Newton Sprague, D.C.
• Raun Spranger
• Sara Spratt
• Spring of Light Homes LLC
• St. Jude Medical & Aesthetic Care Center, LLC
• Kimberly Stabler, OTA
• Dannielle Tremaine Stafford
• Douglas Scott Stafford, D.M.D.
• Brian Patrick Stahl, MD

• Assisted Living Facility in Brandon, FL
• Providers in Brandon, 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 Dec 23, 2013; 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.