Provider Demographics
NPI:1306290747
Name:SANDLAKE-ABILITY HEALTH SERVICES INC
Entity type:Organization
Organization Name:SANDLAKE-ABILITY HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-688-0070
Mailing Address - Street 1:1200 LEXINGTON GREEN LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1013
Mailing Address - Country:US
Mailing Address - Phone:407-688-0070
Mailing Address - Fax:407-688-0071
Practice Address - Street 1:7940 VIA DELLAGIO WAY STE 142
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5400
Practice Address - Country:US
Practice Address - Phone:407-745-4633
Practice Address - Fax:407-745-4635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABILITY HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686675Medicare PIN