Vanderbilt Beach Assisted Living Facility,LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL5582 Issued in FL

Legal business name

VANDERBILT BEACH ASSISTED LIVING FACILITY,LLC

Practice address

517 100TH Ave N
Naples, FL 34108-2235

Phone

(239) 597-5177

Fax

(239) 514-7253

NPI assigned

May 31, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Sandra Lynn Medrano, LPN

Title

Owner/Administrator

Phone

(239) 910-2283

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369958400000",
    "number": "1407293301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 100TH AVE N",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341082235",
            "telephone_number": "239-597-5177",
            "fax_number": "239-514-7253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 100TH AVE N",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341082235",
            "telephone_number": "239-597-5177",
            "fax_number": "239-514-7253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANDERBILT BEACH ASSISTED LIVING FACILITY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-31",
        "last_updated": "2013-05-31",
        "status": "A",
        "authorized_official_last_name": "MEDRANO",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "239-910-2283",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL5582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.