Provider Demographics
NPI:1447873120
Name:BANKWELL SENIOR LIVING
Entity type:Organization
Organization Name:BANKWELL SENIOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:727-906-1034
Mailing Address - Street 1:2620 54TH AVE S APT 52
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-4751
Mailing Address - Country:US
Mailing Address - Phone:727-906-1034
Mailing Address - Fax:
Practice Address - Street 1:3434 54TH AVE SOUTH
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4751
Practice Address - Country:US
Practice Address - Phone:727-906-1034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility