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General NPI Number Information
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NPI Number | 1174872568
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Entity Type | Organization
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Legal Business Name | SL HERON EAST, LLC
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 2290 CATTLEMEN RD
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City | SARASOTA
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State | FL
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Zip | 34232-6277
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Country | US
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Telephone | 941-378-5757
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Fax | 941-343-6152
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Provider Business Mailing Address
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Address Line | 2290 CATTLEMEN RD
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City | SARASOTA
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State | FL
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Zip | 34232-6277
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Country | US
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Telephone | 941-378-5757
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Fax | 941-343-6152
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DONALD BARRY LANDRETH
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Credential |
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Telephone | 941-378-5757
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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 | 9680
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License Number State | FL
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