Healthcare Provider Details

I. General information

NPI: 1457261844
Provider Name (Legal Business Name): SACSAN VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 MEADOW DALE DR
CLEARWATER FL
33764-2504
US

IV. Provider business mailing address

1507 MEADOW DALE DR
CLEARWATER FL
33764-2504
US

V. Phone/Fax

Practice location:
  • Phone: 727-744-4866
  • Fax: 833-840-7170
Mailing address:
  • Phone: 727-744-4866
  • Fax: 833-840-7170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SANUSIE SACCOH
Title or Position: ADMINISTRATOR
Credential:
Phone: 727-744-4866