MEDICARE: SANTA BARBARA SOCIAL CLUB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821758285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA BARBARA SOCIAL CLUB LLC

Provider Business Mailing Address
First Line	:	9321 SW 174TH ST
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-5716
Country	:	US
Telephone Number	:	786-479-2000
Fax Number	:	239-842-6787

Provider Business Practice Location Address
First Line	:	2135 SANTA BARBARA BLVD STE 106-108
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-4359
Country	:	US
Telephone Number	:	239-984-2916
Fax Number	:	239-842-6787

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BORIS L. AVILA
Credential	:
Telephone Number	:	786-479-2000

Provider Enumeration Date	:	12/28/2021
Last Update Date	:	12/28/2021

Similar Medicare Providers

1922517010 — Y&I HEALTHCARE CORP
Practice Location Address:

2135 SANTA BARBARA BLVD
CAPE CORAL, FL
33991-4359

Practice Phone: 239-576-6892
Practice Fax: 239-573-5921

1992145429 — VIRGINIA ZETA SABINO
Practice Location Address:

212 SE 21ST ST
CAPE CORAL, FL
33990-4359

Practice Phone: 239-628-7747
Practice Fax:

1124696455 — DENISSE MARTINEZ TORRES RBT
Practice Location Address:

2212 OASIS PALM CIR APT 202
CAPE CORAL, FL
33991-3753

Practice Phone: 786-707-7490
Practice Fax:

1821500091 — SUSEL MENDOZA ARNP
Practice Location Address:

514 SW 4TH ST
CAPE CORAL, FL
33991-1917

Practice Phone: 305-417-2094
Practice Fax:

1891537668 — LIVING WELL COUNSELING AND CONSULTING LLC
Practice Location Address:

618 SW 3RD ST STE 110
CAPE CORAL, FL
33991-1995

Practice Phone: 239-940-7025
Practice Fax:

1881316776 — VICKI LYNNE BONHAM LMHC
Practice Location Address:

618 SW 3RD ST STE 110
CAPE CORAL, FL
33991-1995

Practice Phone: 239-940-7025
Practice Fax:

Directions to “SANTA BARBARA SOCIAL CLUB LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.