Provider Demographics
NPI:1699196857
Name:SOUTHERN COMFORT BED & BREAKFAST,INC
Entity type:Organization
Organization Name:SOUTHERN COMFORT BED & BREAKFAST,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-376-5942
Mailing Address - Street 1:2409 W RAVINE DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-5635
Mailing Address - Country:US
Mailing Address - Phone:813-645-6361
Mailing Address - Fax:813-645-6377
Practice Address - Street 1:2409 W RAVINE DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-5635
Practice Address - Country:US
Practice Address - Phone:813-645-6361
Practice Address - Fax:813-645-6377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11967693310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility