Provider Demographics
NPI:1144957002
Name:SUMMERFIELD SENIOR LIVING OF GULFPORT LLC
Entity type:Organization
Organization Name:SUMMERFIELD SENIOR LIVING OF GULFPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-931-3111
Mailing Address - Street 1:14744 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-8582
Mailing Address - Country:US
Mailing Address - Phone:228-678-1100
Mailing Address - Fax:
Practice Address - Street 1:14744 N SWAN RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-8582
Practice Address - Country:US
Practice Address - Phone:228-678-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility