Provider Demographics
NPI:1285274910
Name:IHS AL SRQ, LLC
Entity type:Organization
Organization Name:IHS AL SRQ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LIZAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-362-4753
Mailing Address - Street 1:240 N WASHINGTON BLVD STE 430
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5933
Mailing Address - Country:US
Mailing Address - Phone:941-362-4753
Mailing Address - Fax:941-362-4766
Practice Address - Street 1:4612 MCINTOSH RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1931
Practice Address - Country:US
Practice Address - Phone:941-923-3309
Practice Address - Fax:941-923-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL11383OtherAHCA LICENSE