Healthcare Provider Details

I. General information

NPI: 1912378514
Provider Name (Legal Business Name): SOLARIS HEALTHCARE WINDERMERE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4875 CASON COVE DR
ORLANDO FL
32811-6302
US

IV. Provider business mailing address

PO BOX 3310
WINDERMERE FL
34786-3310
US

V. Phone/Fax

Practice location:
  • Phone: 407-420-2090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BOBBY PATE
Title or Position: MANAGER
Credential:
Phone: 407-420-2090