Nic 4 Southern Gardens Leasing LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

8937 Issued in FL

Legal business name

NIC 4 SOUTHERN GARDENS LEASING LLC

Doing business as

Southern Gardens

Practice address

255 E Main St
Lake Alfred, FL 33850-2133

Phone

(212) 479-5343

NPI assigned

Apr 29, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Brian Sigman

Title

Cfo

Phone

(212) 479-5343

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Southern Gardens Doing business as

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

{
    "created_epoch": "1367193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367193600000",
    "number": "1710321112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 E MAIN ST",
            "city": "LAKE ALFRED",
            "state": "FL",
            "postal_code": "338502133",
            "telephone_number": "212-479-5343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 E MAIN ST",
            "city": "LAKE ALFRED",
            "state": "FL",
            "postal_code": "338502133",
            "telephone_number": "212-479-5343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIC 4 SOUTHERN GARDENS LEASING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-29",
        "last_updated": "2013-04-29",
        "status": "A",
        "authorized_official_last_name": "SIGMAN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "212-479-5343",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "8937",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID AL WAIVER",
            "identifier": "689986200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID ACS",
            "identifier": "1423860",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Gardens",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Lake Alfred, FL
• Providers in Lake Alfred, 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 Apr 29, 2013; 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.