Provider Demographics
NPI:1063407914
Name:SARASOTA ELDER CARE INC
Entity type:Organization
Organization Name:SARASOTA ELDER CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF AR
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-820-8409
Mailing Address - Street 1:100 2ND AVE S
Mailing Address - Street 2:STE 901S
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4360
Mailing Address - Country:US
Mailing Address - Phone:727-820-8409
Mailing Address - Fax:727-822-8302
Practice Address - Street 1:5157 PARK CLUB DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-1801
Practice Address - Country:US
Practice Address - Phone:941-377-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF#1492096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMEDICARE NUMBERMedicaid
FLMEDICARE NUMBERMedicaid