Healthcare Provider Details

I. General information

NPI: 1689337263
Provider Name (Legal Business Name): LSLH SUGARLOAF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 SATELLITE BLVD NW
SUWANEE GA
30024-4895
US

IV. Provider business mailing address

PO BOX 2301
STILLWATER MN
55082-2301
US

V. Phone/Fax

Practice location:
  • Phone: 678-990-4580
  • Fax:
Mailing address:
  • Phone: 651-342-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGG FOX
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 651-342-2780