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Organization
SUMMERVILLE AT PORT ORANGE, INC.
Active
Organization
SUMMERVILLE AT PORT ORANGE, INC.
Active
Other names
Brookdale Yorktowne
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN RICHARDSON (EVP, CHIEF ADMIN. OFFICER)
(615) 564-8131
Entity
Organization
Contact information
Practice address
1675 DUNLAWTON AVE, PORT ORANGE, FL 32127-4755
(386) 761-1055
(386) 761-4408
Mailing address
6737 W WASHINGTON ST, SUITE 2300, MILWAUKEE, WI 53214-5647
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL9792
FL
311500000X
Alzheimer Center (Dementia Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0111336-00
—
FL
Enumeration date
07/15/2008
Last updated
05/13/2016
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