Indian Shore Manor, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12464 Issued in FL

Legal business name

INDIAN SHORE MANOR, LLC

Practice address

1611 Indian Shore Dr
Clermont, FL 34711-2981

Phone

(352) 404-8571

NPI assigned

Jul 29, 2014

Organization subpart

No

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

Authorized official

Name

Merita Mason

Title

Administrator

Phone

(718) 344-3828

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1406592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406592000000",
    "number": "1639587108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 INDIAN SHORE DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347112981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 INDIAN SHORE DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347112981",
            "telephone_number": "352-404-8571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN SHORE MANOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-29",
        "last_updated": "2014-07-29",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "MERITA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "718-344-3828"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Clermont, FL
• Providers in Clermont, 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 Jul 29, 2014; 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.