Healthcare Provider Details

I. General information

NPI: 1083165021
Provider Name (Legal Business Name): SOLARIS HEALTHCARE OSCEOLA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 NOLTE RD
SAINT CLOUD FL
34772-7158
US

IV. Provider business mailing address

PO BOX 110881
NAPLES FL
34108-0115
US

V. Phone/Fax

Practice location:
  • Phone: 407-957-3341
  • 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: BOB PATE
Title or Position: MANAGER
Credential:
Phone: 407-957-3341