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SOUTHERN GARDENS
NPI 1710321112
Assisted Living Facility in Lake Alfred, FL

Active since April 29, 2013
255 E MAIN ST, LAKE ALFRED, FL 33850(212) 479-5343 Get Directions Write a Review

NPPES record last updated: April 29, 2013. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Southern Gardens NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN GARDENS (NPI 1710321112) is a healthcare organization registered as an assisted living facility in Lake Alfred, Florida and active in the NPI registry since April 2013. The organization lists Brian Sigman, Cfo, as its authorized official.

NPPES Registry Identity

NPI1710321112
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameNIC 4 SOUTHERN GARDENS LEASING LLC
Location Address255 E MAIN STLake Alfred, FL 33850-2133
Mailing Address255 E Main StLake Alfred, FL 33850-2133 · (212) 479-5343
Phone(212) 479-5343
Organization SubpartNo
Authorized OfficialBrian SigmanCfo · (212) 479-5343
Enumeration DateApril 29, 2013
✔ NPI 1710321112 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in FL · 8937
Definition
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.
255 E MAIN ST, Lake Alfred, FL 33850
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Other Names 1

Doing Business AsSouthern Gardens

Other Identifiers 2

Other689986200FL · Medicaid Al Waiver
Other1423860FL · Medicaid Acs

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANDREA DON REXROAD PTA
Physical Therapy Assistant
255 E MAIN ST
LAKE ALFRED, FL 33850
Polk County (863) 956-0411
MRS. CAITLIN COULTON COTA/L
Occupational Therapy Assistant
255 E MAIN ST
LAKE ALFRED, FL 33850
Polk County (863) 956-0411
SHERI ANNETTE FOLLIS PTA
Physical Therapy Assistant
255 E MAIN ST
LAKE ALFRED, FL 33850
Polk County (863) 662-5690
SOUTHERN GARDENS, LLC
Assisted Living Facility
255 E MAIN ST
LAKE ALFRED, FL 33850
Polk County (863) 956-0411
SOUTHERN GARDENS FL AL MANAGEMENT LLC
Assisted Living Facility
255 E MAIN ST
LAKE ALFRED, FL 33850
Polk County (863) 956-0411
DR. KYLIE T ODPARLIK PT, DPT
Physical Therapist
255 E MAIN ST
LAKE ALFRED, FL 33850
Polk County (863) 956-0411
TARA WOODWARD PTA
Physical Therapy Assistant
255 E MAIN ST
LAKE ALFRED, FL 33850
Polk County (863) 956-0411
JEFF GALLICHAN PTA
Physical Therapy Assistant
255 E MAIN ST
LAKE ALFRED, FL 33850
Polk County (727) 803-1102

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nic 4 Southern Gardens Leasing LLC's NPI number?

The NPI number for Nic 4 Southern Gardens Leasing LLC is 1710321112. It was assigned to this organization in the NPPES registry on April 29, 2013. The provider is doing business as Southern Gardens.

Where is Nic 4 Southern Gardens Leasing LLC located?

Nic 4 Southern Gardens Leasing LLC is located at 255 E Main St, Lake Alfred, FL 33850. The listed phone number is (212) 479-5343.

What is Nic 4 Southern Gardens Leasing LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Nic 4 Southern Gardens Leasing LLC was last updated on April 29, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.