Provider Demographics
NPI:1023407046
Name:SENIOR LIVING III SRQ LLC
Entity type:Organization
Organization Name:SENIOR LIVING III SRQ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RISK MGMT & COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABREU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-330-2660
Mailing Address - Street 1:4301 ANCHOR PLAZA PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7529
Mailing Address - Country:US
Mailing Address - Phone:813-330-2660
Mailing Address - Fax:844-808-0071
Practice Address - Street 1:1900 PHILLIPPI SHORES DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3205
Practice Address - Country:US
Practice Address - Phone:941-404-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311500000X
FLAL12463310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)