Organization
SPRUCE CREEK ASSISTED LIVING ,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHARLENE GREENE (ADMINISTRATOR)
(407) 310-9405
Entity
Organization
Contact information
Practice address
762 COBBLESTONE WAY, ORMOND BEACH, FL 32174-1026
(407) 310-9405
Mailing address
5953 BROKEN BOW LN, PORT ORANGE, FL 32127-7581
(386) 872-6155
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
12422
FL
Other
Enumeration date
03/22/2017
Last updated
03/22/2017
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