Healthcare Provider Details

I. General information

NPI: 1811993025
Provider Name (Legal Business Name): SA-PG-OCALA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SW 34TH ST
OCALA FL
34474-4470
US

IV. Provider business mailing address

2700 SW 34TH ST
OCALA FL
34474-4470
US

V. Phone/Fax

Practice location:
  • Phone: 352-854-6262
  • Fax: 352-861-2009
Mailing address:
  • Phone: 352-854-6262
  • Fax: 352-861-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1411096
License Number StateFL

VIII. Authorized Official

Name: MR. ALEX PALEY
Title or Position: COO
Credential:
Phone: 914-390-4363