Summerville 9 LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL10143 Issued in FL

Legal business name

SUMMERVILLE 9 LLC

Practice address

2155 Montclair Rd
Clearwater, FL 33763-4287

Phone

(727) 797-7257

NPI assigned

Nov 17, 2009

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 Beckett Lake Doing business as

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

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463097600000",
    "number": "1609103308",
    "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": "2155 MONTCLAIR RD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337634287",
            "telephone_number": "727-797-7257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERVILLE 9 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-17",
        "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": "AL10143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0110301-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale Beckett Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Garry Sullivan
• Jeremiah Sullivan, DPT
• Kathleen Sullivan, RN
• Sumilang Health Care LLC
• Summer Set Diagnostics LLC
• Summerville at Clearwater LLC
• Summit Behavioral Therapy LLC
• Shannon L Sumner
• Sun Coast Eye Care Inc
• Sun Miracle Wellness Center LLC

• All providers in Clearwater, FL
• 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.