Summerville 16, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL9294 Issued in FL

Legal business name

SUMMERVILLE 16, LLC

Doing business as

Brookdale Jensen Beach

Practice address

1700 NE Indian River Dr
Jensen Beach, FL 34957-5853

Phone

(772) 225-1355

NPI assigned

May 14, 2008

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 2

Addresses

Other identifiers 1

Other names 1

• Brookdale Jensen Beach Doing business as

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463097600000",
    "number": "1447427703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6737 W WASHINGTON ST",
            "address_2": "SUITE 2300",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532145647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 NE INDIAN RIVER DR",
            "city": "JENSEN BEACH",
            "state": "FL",
            "postal_code": "349575853",
            "telephone_number": "772-225-1355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERVILLE 16, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-14",
        "last_updated": "2016-05-13",
        "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": "AL9294",
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "FL",
            "license": "AL9294",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0118952-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale Jensen Beach",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Stoler, M.D.
• Sally Strand, LMHC
• Carolynn Suzanne Strom, RN, CDE
• David Warren Strong, M.D.
• Abed M Suleiman, PHARM.D.
• Sunray Rehab Inc
• Sunshine State of Mind Counseling PLLC
• Jenevieve Rose Tapper, M.S. CF-SLP
• Jamie Taravella
• Lindsey N Tate, SLP

• Assisted Living Facility in Jensen Beach, FL
• Providers in Jensen 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 May 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.