Organization
KIVA AT CANTERBURY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS SCARBOROUGH (OWNER)
(615) 397-5271
Entity
Organization
Contact information
Practice address
10 7TH ST, BONITA SPRINGS, FL 34134-7415
(239) 992-8599
Mailing address
10 7TH ST, BONITA SPRINGS, FL 34134-7415
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL7622
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
693447100
MEDICAID WAIVER
FL
Enumeration date
10/18/2012
Last updated
10/18/2012
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