Healthcare Provider Details

I. General information

NPI: 1568582617
Provider Name (Legal Business Name): SHERBY DEVELOPMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 LINCOLN ST
HOLLYWOOD FL
33020-3917
US

IV. Provider business mailing address

PO BOX 221650
HOLLYWOOD FL
33022-1650
US

V. Phone/Fax

Practice location:
  • Phone: 954-922-1995
  • Fax: 954-923-1766
Mailing address:
  • Phone: 954-922-1995
  • Fax: 954-923-1766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL5672
License Number StateFL

VIII. Authorized Official

Name: MR. LARRY SHERBERG
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-922-1995