Provider Demographics
NPI:1316719909
Name:SBSG EQUITY GROUP, LLC
Entity type:Organization
Organization Name:SBSG EQUITY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERONIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-258-6467
Mailing Address - Street 1:1100 MELODY LN STE 1040
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5203
Mailing Address - Country:US
Mailing Address - Phone:916-794-2288
Mailing Address - Fax:
Practice Address - Street 1:1100 MELODY LN STE 1040
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5203
Practice Address - Country:US
Practice Address - Phone:916-794-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care