Summerville at Carrollwood, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL9134 Issued in FL

Legal business name

SUMMERVILLE AT CARROLLWOOD, LLC

Doing business as

Brookdale Carollwood

Practice address

13550 South Village Drive
Tampa, FL 33618

Phone

(813) 908-5300

Fax

(813) 908-5304

NPI assigned

May 23, 2007

Organization subpart

No

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

Authorized official

Name

Byran Richardson

Title

Evp, Chief Admin. Officer

Phone

(615) 564-8131

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Brookdale Carollwood Doing business as

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465776000000",
    "number": "1922218361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6737 W WASHINGTON ST STE 2300",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532145650",
            "telephone_number": "414-918-5000",
            "fax_number": "925-866-8468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13550 SOUTH VILLAGE DRIVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33618",
            "telephone_number": "813-908-5300",
            "fax_number": "813-908-5304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERVILLE AT CARROLLWOOD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2016-06-13",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "BYRAN",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL9134",
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0111609-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale Carollwood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Earlene Alicia Summerline - Steele, OTR
• Christopher Summers, PH.D.
• Eileen W Summers
• Juliet Aleene Summers, PAC
• Megan Raeanne Summers
• Tanna Morris Summerville, RN
• Summit Health Multi Specialty of Florida LLC
• Summit Health Specialists, P.L.
• Summit Investment LLC (Bay Area Pharmacy 2)
• Summit Investment LLC (Bay Area Pharmacy)

• Assisted Living Facility in Tampa, FL
• Providers in Tampa, 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 Jun 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.