Summerville 15, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL9384 Issued in FL

Legal business name

SUMMERVILLE 15, LLC

Practice address

8220 Jog Rd
Boynton Beach, FL 33472-2938

Phone

(561) 733-3200

NPI assigned

Nov 17, 2009

Organization subpart

No

Name

Bryan Richardson

Title

Evp, Chief Admin. Officer

Phone

(615) 564-8131

• Brookdale West Boynton Beach Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 13, 2016.

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463097600000",
    "number": "1790012482",
    "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": "8220 JOG RD",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334722938",
            "telephone_number": "561-733-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERVILLE 15, 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": "AL9384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0118960-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale West Boynton Beach",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Boynton Beach, 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.