Provider Demographics
NPI:1427453679
Name:SUN PALMS ADULT DAY CARE LLC
Entity type:Organization
Organization Name:SUN PALMS ADULT DAY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HOPLYN
Authorized Official - Middle Name:MCSEINE
Authorized Official - Last Name:BEATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-935-5485
Mailing Address - Street 1:5568 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-2101
Mailing Address - Country:US
Mailing Address - Phone:315-935-5485
Mailing Address - Fax:
Practice Address - Street 1:12717 GULFSTREAM BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33981-6721
Practice Address - Country:US
Practice Address - Phone:315-935-5485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9292261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care