MEDICARE: SB ALBERT 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	251C00000X	Developmentally Disabled Services Day Training Agency	234225	FL
2	251E00000X	Home Health Agency	234225	FL
3	251S00000X	Community/Behavioral Health Agency	234225	FL
4	253Z00000X	In Home Supportive Care Agency	234225	FL

General Provider Information

NPI Number	:	1942664149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SB ALBERT LLC

Provider Business Mailing Address
First Line	:	5240 COMPASS POINTE CIR
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32966-2120
Country	:	US
Telephone Number	:	772-217-3190
Fax Number	:

Provider Business Practice Location Address
First Line	:	5240 COMPASS POINTE CIR
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32966-2120
Country	:	US
Telephone Number	:	772-217-3190
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRENT ALBERT
Credential	:
Telephone Number	:	772-217-3190

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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