Organization
STILLWATER ASSISTED LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN SHARPE (OWNER)
(865) 816-7433
Entity
Organization
Contact information
Practice address
12413 RIVERGLEN DR, RIVERVIEW, FL 33569-8213
(813) 398-3000
Mailing address
7412 CACTUS DAHLIA AVE, TAMPA, FL 33619-6910
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110588200
—
FL
Enumeration date
09/15/2021
Last updated
09/15/2021
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