Silver Lake Village, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SILVER LAKE VILLAGE, INC

Doing business as

Silver Lake Village

Practice address

34601 Radio Rd
Leesburg, FL 34788-3301

Phone

(503) 833-2814

NPI assigned

Mar 19, 2020

Last updated

Mar 19, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samuel Bongiovanni

Title

President

Phone

(503) 833-2814

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Silver Lake Village Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1584576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584576000000",
    "number": "1952937112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33857 TERRAGONA DR",
            "city": "SORRENTO",
            "state": "FL",
            "postal_code": "327766918",
            "telephone_number": "503-833-2814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34601 RADIO RD",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347883301",
            "telephone_number": "503-833-2814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILVER LAKE VILLAGE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-19",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A",
        "authorized_official_last_name": "BONGIOVANNI",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-833-2814"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NONE",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "care@slvillage.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "34601 Radio Rd",
            "city": "Leesburg",
            "state": "FL",
            "country_code": "US",
            "postal_code": "347883301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Silver Lake Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Leesburg, FL
• Providers in Leesburg, 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 Mar 19, 2020; 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.