NPI 1306433644
Southern Ave Sp LLC
Practice location
- Address
- 4656 Livingston Rd. SE, Washington DC, DC 20032
- Phone
- (260) 755-2292
- Mailing address
- 3630 Illinois Rd, Fort Wayne, IN 46804-2062
Authorised official
- Name
- Ryan Person
- Title
- Director of Business Development
- Phone
- (260) 413-4159
Registered specialties
Assisted Living Facility
Primary
Registry record
- NPI
- 1306433644
- Entity type
- Organization
- NPI issued
- 21 Dec 2020
- Record last updated
- 26 Jan 2021
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.