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General NPI Number Information
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NPI Number | 1013313246
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Entity Type | Organization
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Legal Business Name | SUNSET VILLA RETIREMENT HOME
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 2308 AMERICUS DR
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City | CLEARWATER
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State | FL
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Zip | 33763-4503
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Country | US
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Telephone | 727-799-6595
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Fax |
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Provider Business Mailing Address
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Address Line | 2308 AMERICUS DR.
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City | CLEARWATER
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State | FL
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Zip | 33763
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Country | US
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Telephone | 727-799-6595
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ELIZER ALCANTARA DIOSO JR.
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Credential |
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Telephone | 727-799-6595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL6134
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License Number State | FL
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