Organization · Type 2 NPI

Southern Ave SP LLC

Assisted Living Facility · Washington Dc, DC

NPI number 1306433644 Active

Practice location

4656 Livingston Rd. SE
Washington Dc, DC 20032

Call (260) 755-2292 Map

Mailing address

3630 Illinois Rd
Fort Wayne, IN 46804-2062

Specialties and licenses

Taxonomy	Code	License
Assisted Living Facility Primary	310400000X	None listed

Assisted Living Facility: A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

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NPI record

NPI: 1306433644
Entity type: Organization (Type 2)
Issued: Dec 21, 2020
Last updated: Jan 26, 2021
Status: Active

Other names

<unavail>
Livingston Place · doing business as
Livingston Place at Southern Avenue · doing business as

Authorized official

Ryan Person
Director of Business Development
(260) 413-4159

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1306433644

Southern Ave SP LLC's National Provider Identifier is 1306433644, issued on Dec 21, 2020. The primary taxonomy on file is Assisted Living Facility (310400000X), and the practice location is in Washington Dc, DC. The record was last updated on Jan 26, 2021.