Organization
SOUTHERN AVE SP LLC
Active
Other names
Livingston Place at Southern Avenue, Livingston Place
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN PERSON (DIRECTOR OF BUSINESS DEVELOPMENT)
(260) 413-4159
Entity
Organization
Contact information
Practice address
4656 LIVINGSTON RD. SE, WASHINGTON DC, DC 20032
(260) 755-2292
Mailing address
3630 ILLINOIS RD, FORT WAYNE, IN 46804-2062
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
12/21/2020
Last updated
01/26/2021
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