Provider Demographics
NPI:1932916582
Name:SANDALWOOD SKILLED NURSING HEALTH, LLC
Entity type:Organization
Organization Name:SANDALWOOD SKILLED NURSING HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:
Authorized Official - Last Name:USITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-234-2009
Mailing Address - Street 1:11710 PLAZA AMERICA DR STE 2000
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4743
Mailing Address - Country:US
Mailing Address - Phone:571-234-2008
Mailing Address - Fax:
Practice Address - Street 1:11710 PLAZA AMERICA DR STE 2000
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4743
Practice Address - Country:US
Practice Address - Phone:571-234-2008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health