Organization
SH NORTHDALE, LLC
Active
Other names
THE COLONNADE AT NORTHDALE
Organization subpart
No
Provider details
NPI number
Authorized official
SETH WALKER (CFO)
(850) 583-7990
Entity
Organization
Contact information
Practice address
3401 W BEARSS AVE, TAMPA, FL 33618-2143
(813) 961-1044
Mailing address
2573 BARRINGTON CIR, TALLAHASSEE, FL 32308-6805
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104709900
—
FL
01
—
9500
ALF LICENSE
FL
Enumeration date
12/05/2019
Last updated
02/26/2020
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