Healthcare Provider Details

I. General information

NPI: 1144156985
Provider Name (Legal Business Name): GILLESPIE GROVE HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 18TH ST
SARASOTA FL
34234-8657
US

IV. Provider business mailing address

1755 18TH ST
SARASOTA FL
34234-8657
US

V. Phone/Fax

Practice location:
  • Phone: 941-955-4915
  • Fax: 949-540-3007
Mailing address:
  • Phone: 941-955-4915
  • Fax: 949-540-3007

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: SOON BURNAM
Title or Position: SECRETARY
Credential:
Phone: 949-540-1249