Summerville at Clearwater LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL6670 Issued in FL

Legal business name

SUMMERVILLE AT CLEARWATER LLC

Practice address

2750 Drew Street
Clearwater, FL 33759

Phone

(727) 799-2177

Fax

(727) 726-4145

NPI assigned

May 24, 2007

Organization subpart

No

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

Authorized official

Name

Bryan Richardson

Title

Evp, Chief Admin. Officer

Phone

(615) 564-8131

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brookdale Clearwater Doing business as

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465776000000",
    "number": "1275744138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6737 W WASHINGTON ST STE 2300",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532145650",
            "telephone_number": "414-918-5000",
            "fax_number": "925-866-8468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 DREW STREET",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "33759",
            "telephone_number": "727-799-2177",
            "fax_number": "727-726-4145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERVILLE AT CLEARWATER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2016-06-13",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "EVP, CHIEF ADMIN. OFFICER",
        "authorized_official_telephone_number": "615-564-8131"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL6670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0110369-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale Clearwater",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeremiah Sullivan, DPT
• Kathleen Sullivan, RN
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• Summerville 9 LLC
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• Shannon L Sumner
• Sun Coast Eye Care Inc
• Sun Miracle Wellness Center LLC
• Sun States Services, Inc

• Assisted Living Facility in Clearwater, FL
• Providers in Clearwater, 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 13, 2016; 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.