Organization
NIC 4 SOUTHERN GARDENS LEASING LLC
Active
Other names
Southern Gardens
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN SIGMAN (CFO)
(212) 479-5343
Entity
Organization
Contact information
Practice address
255 E MAIN ST, LAKE ALFRED, FL 33850-2133
(212) 479-5343
Mailing address
255 E MAIN ST, LAKE ALFRED, FL 33850-2133
(212) 479-5343
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
8937
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1423860
MEDICAID ACS
FL
01
—
689986200
MEDICAID AL WAIVER
FL
Enumeration date
04/29/2013
Last updated
04/29/2013
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