Edenville Manor LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL 11968190 Issued in FL

Legal business name

EDENVILLE MANOR LLC

Practice address

721 Edenville Ave
Clearwater, FL 33764-6339

Phone

(727) 726-7242

Fax

(727) 726-7211

NPI assigned

Feb 29, 2012

Last updated

Feb 29, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Prosper K Bonuedie

Title

Administrator

Phone

(727) 726-7242

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1330473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330473600000",
    "number": "1467726091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 EDENVILLE AVE",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337646339",
            "telephone_number": "727-726-7242",
            "fax_number": "727-726-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 EDENVILLE AVE",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337646339",
            "telephone_number": "727-726-7242",
            "fax_number": "727-726-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDENVILLE MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-29",
        "last_updated": "2012-02-29",
        "status": "A",
        "authorized_official_last_name": "BONUEDIE",
        "authorized_official_first_name": "PROSPER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "727-726-7242",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL 11968190",
            "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 Feb 29, 2012; 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.