SH Northdale, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SH NORTHDALE, LLC

Practice address

3401 W Bearss Ave
Tampa, FL 33618-2143

Phone

(813) 961-1044

NPI assigned

Dec 5, 2019

Organization subpart

No

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

Authorized official

Name

Seth Walker

Title

Cfo

Phone

(850) 583-7990

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• THE COLONNADE AT NORTHDALE Doing business as

Locations

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

{
    "created_epoch": "1575504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582675200000",
    "number": "1558908855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2573 BARRINGTON CIR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323086805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 W BEARSS AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336182143",
            "telephone_number": "813-961-1044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SH NORTHDALE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-05",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "SETH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "850-583-7990"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104709900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALF LICENSE",
            "identifier": "9500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE COLONNADE AT NORTHDALE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "THE COLONNADE AT NORTHDALE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Annette Keely Seymour
• Marley Megan Seymour, OTD, OTR/L
• SF Tampa LLC
• SGF Tampa Bay LLC
• SH Carrollwood, LLC
• Elena Shackelford, OT
• Margaret Shackelford
• Nathan Shadd
• Megan Elizabeth Shader, PHARM.D.
• Shady Oaks Living Center

• Assisted Living Facility in Tampa, FL
• Providers in Tampa, 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 Feb 26, 2020; 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.