Provider Demographics
NPI:1912277377
Name:T
Entity type:Organization
Organization Name:T
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A
Authorized Official - Prefix:
Authorized Official - First Name:N
Authorized Official - Middle Name:
Authorized Official - Last Name:R
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-864-9191
Mailing Address - Street 1:2600 COURTLAND ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-7633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 COURTLAND ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7633
Practice Address - Country:US
Practice Address - Phone:305-864-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility