Organization
SILVER LAKE VILLAGE, INC
Active
Other names
Silver Lake Village
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL BONGIOVANNI (PRESIDENT)
(503) 833-2814
Entity
Organization
Contact information
Practice address
34601 RADIO RD, LEESBURG, FL 34788-3301
(503) 833-2814
Mailing address
33857 TERRAGONA DR, SORRENTO, FL 32776-6918
(503) 833-2814
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NONE
—
FL
Enumeration date
03/19/2020
Last updated
03/19/2020
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