Organization
SHP III HERON FORT MYERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN DARK (VP)
(770) 395-8635
Entity
Organization
Contact information
Practice address
9731 COMMERCE CENTER CT, FORT MYERS, FL 33908-1400
(239) 334-2500
Mailing address
2 RAVINIA DR, SUITE 400, ATLANTA, GA 30346-2104
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
LICENSE PENDING
FL
Other
Enumeration date
07/12/2007
Last updated
07/12/2007
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