Provider Demographics
NPI:1366117111
Name:SENIOR LIVING VI LAKEWOOD RANCH, LLC
Entity type:Organization
Organization Name:SENIOR LIVING VI LAKEWOOD RANCH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RM & 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 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7521
Mailing Address - Country:US
Mailing Address - Phone:813-330-2660
Mailing Address - Fax:844-808-0071
Practice Address - Street 1:5424 LENA RD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9448
Practice Address - Country:US
Practice Address - Phone:941-782-0148
Practice Address - Fax:844-808-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111704600Medicaid
FLAL12727OtherAHCA LICENSE