Specially Fit Foundation

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SPECIALLY FIT FOUNDATION

Practice address

2224 Arch McDonald Dr
Dover, FL 33527-6342

Phone

(727) 831-2829

NPI assigned

Jan 12, 2022

Organization subpart

No

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

Authorized official

Name

Mark Stephan Oliver

Title

Certified Alf Admin

Phone

(813) 389-9474

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1641945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1881345684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11118 LAKESIDE VISTA DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335692919",
            "telephone_number": "727-831-2829",
            "fax_number": "888-814-0945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2224 ARCH MCDONALD DR",
            "city": "DOVER",
            "state": "FL",
            "postal_code": "335276342",
            "telephone_number": "727-831-2829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALLY FIT FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-12",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "STEPHAN",
        "authorized_official_title_or_position": "CERTIFIED ALF ADMIN",
        "authorized_official_telephone_number": "813-389-9474"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Dover, FL
• Providers in Dover, 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 12, 2022; 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.