Summerville at Golden Pond, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL4712 Issued in FL

Legal business name

SUMMERVILLE AT GOLDEN POND, LLC

Doing business as

Brookdale Palma Sola

Practice address

450 67TH Street North
Bradenton, FL 34209

Phone

(941) 794-5657

Fax

(941) 798-3521

NPI assigned

May 21, 2007

Last updated

Jun 13, 2016By 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

Byran Richardson

Title

Evp, Chief Admin. Officer

Phone

(615) 564-8131

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Brookdale Palma Sola Doing business as

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465776000000",
    "number": "1629287420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6737 W WASHINGTON ST STE 2300",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532145650",
            "telephone_number": "414-918-5000",
            "fax_number": "206-301-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 67TH STREET NORTH",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "34209",
            "telephone_number": "941-794-5657",
            "fax_number": "941-798-3521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERVILLE AT GOLDEN POND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2016-06-13",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "BYRAN",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL4712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06905137-00",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140353200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale Palma Sola",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Bradenton, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 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.