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General NPI Number Information
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NPI Number | 1275297749
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Entity Type | Organization
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Legal Business Name | SOUTH SEAS ALF CARE LLC DBA SOUTH SEAS ALF
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Dates
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Enumeration Date | 10/29/2021
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Last Update Date | 10/29/2021
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Provider Practice Location Address
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Address Line | 101 MCABEE CT
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City | GULF BREEZE
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State | FL
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Zip | 32561-4756
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Country | US
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Telephone | 850-934-1061
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Fax | 850-934-6932
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Provider Business Mailing Address
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Address Line | 101 MCABEE CT
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City | GULF BREEZE
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State | FL
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Zip | 32561-4756
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Country | US
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Telephone | 850-934-1061
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Fax | 850-934-6932
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LAURISSA J GRINNELL
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Credential | RN
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Telephone | 817-902-7977
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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 |
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License Number State |
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