Provider Demographics
NPI:1871061655
Name:SEACOAST AT SUMMERS POINTE LLC
Entity type:Organization
Organization Name:SEACOAST AT SUMMERS POINTE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-341-2712
Mailing Address - Street 1:1868 HIGHLAND OAKS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559
Mailing Address - Country:US
Mailing Address - Phone:813-341-2712
Mailing Address - Fax:815-935-1992
Practice Address - Street 1:1 SUNSET DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-9251
Practice Address - Country:US
Practice Address - Phone:813-341-2712
Practice Address - Fax:765-584-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300072238Medicaid