Healthcare Provider Details

I. General information

NPI: 1952644833
Provider Name (Legal Business Name): SANJEAN FACILITY CARE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 24TH ST
ORLANDO FL
32805-5406
US

IV. Provider business mailing address

815 24TH ST
ORLANDO FL
32805-5406
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-8857
  • Fax:
Mailing address:
  • Phone: 407-704-8857
  • Fax: 561-422-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number11563
License Number StateFL

VIII. Authorized Official

Name: LOUIS JEAN ISAAC
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-704-8857