Senior Care Livingiv LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

License

AL12617 Issued in FL

Legal business name

SENIOR CARE LIVINGIV LLC

Doing business as

Inspired Living at Palm Bay

Practice address

350 Malabar Rd SW
Palm Bay, FL 32907-2947

Phone

(321) 574-6290

NPI assigned

Sep 18, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Mark C Bouldin

Title

Manager

Phone

(727) 592-8889

Specialties & licenses 1

Addresses

Other names 1

• Inspired Living at Palm Bay Doing business as

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

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442534400000",
    "number": "1972972099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 MALABAR RD SW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329072947",
            "telephone_number": "321-574-6290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 MALABAR RD SW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329072947",
            "telephone_number": "321-574-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR CARE LIVINGIV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-18",
        "last_updated": "2015-09-18",
        "status": "A",
        "authorized_official_last_name": "BOULDIN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "727-592-8889",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "FL",
            "license": "AL12617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Inspired Living at Palm Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tanya Seeley
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• Alzheimer Center (Dementia Center) in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Alzheimer Center (Dementia Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; 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.