Southern Living of Titusville

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12517 Issued in FL

Legal business name

SOUTHERN LIVING OF TITUSVILLE

Practice address

2375 E Jay Jay Rd
Titusville, FL 32796-1316

Phone

(321) 225-4668

Fax

(321) 225-4668

NPI assigned

Jan 4, 2017

Organization subpart

No

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

Authorized official

Name

Ms. Lisa Waring

Title

Owner/Administrator

Phone

(321) 225-4668

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1483488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483488000000",
    "number": "1659816403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2375 E JAY JAY RD",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327961316",
            "telephone_number": "321-225-4668",
            "fax_number": "321-225-4668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 E JAY JAY RD",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327961316",
            "telephone_number": "321-225-4668",
            "fax_number": "321-225-4668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN LIVING OF TITUSVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-04",
        "last_updated": "2017-01-04",
        "status": "A",
        "authorized_official_last_name": "WARING",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "321-225-4668",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaime Brooke Smyth
• Mohamed Aly Soliman
• Michael Sorbello, DO
• Renee Lok-Yee Wong Soucier, MD
• South Titusville Medical Center Inc
• Sovereign Healthcare of Titusville, LLC
• Space Coast Assisted Living LLC
• Space Coast Health Centers Inc
• Space Coast Medical Associates LLP
• Space Coast Medical Center

• Assisted Living Facility in Titusville, FL
• Providers in Titusville, 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 Jan 4, 2017; 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.