Provider Demographics
NPI:1730811746
Name:STILLWATER ASSISTED LIVING, LLC
Entity type:Organization
Organization Name:STILLWATER ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-816-7433
Mailing Address - Street 1:7412 CACTUS DAHLIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-6910
Mailing Address - Country:US
Mailing Address - Phone:865-816-7433
Mailing Address - Fax:813-441-8898
Practice Address - Street 1:504 APACHE TRL
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8048
Practice Address - Country:US
Practice Address - Phone:865-816-7433
Practice Address - Fax:813-441-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility