Healthcare Provider Details

I. General information

NPI: 1902214018
Provider Name (Legal Business Name): SABRENA'S RETIREMENT RESORT INC. 4
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 HIAWASSEE OAK DR
ORLANDO FL
32818-8354
US

IV. Provider business mailing address

7000 HIAWASSEE OAK DR
ORLANDO FL
32818-8354
US

V. Phone/Fax

Practice location:
  • Phone: 407-299-4290
  • Fax: 407-294-4728
Mailing address:
  • Phone: 407-299-4290
  • Fax: 407-294-4728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberAL10663
License Number StateFL

VIII. Authorized Official

Name: SUKHRA SAMAROO
Title or Position: PRESIDENT
Credential:
Phone: 407-293-6800