Provider Demographics
NPI:1306289228
Name:DESOTO PALMS LLC
Entity type:Organization
Organization Name:DESOTO PALMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:941-355-0303
Mailing Address - Street 1:5601 N HONORE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-6223
Mailing Address - Country:US
Mailing Address - Phone:941-355-0303
Mailing Address - Fax:941-554-7445
Practice Address - Street 1:5601 N HONORE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-6223
Practice Address - Country:US
Practice Address - Phone:941-355-0303
Practice Address - Fax:941-556-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11835310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility