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General NPI Number Information
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NPI Number | 1306289228
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Entity Type | Organization
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Legal Business Name | DESOTO PALMS LLC
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 5601 N HONORE AVE
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City | SARASOTA
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State | FL
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Zip | 34243-6223
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Country | US
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Telephone | 941-355-0303
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Fax | 941-556-7445
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Provider Business Mailing Address
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Address Line | 5601 N HONORE AVE
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City | SARASOTA
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State | FL
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Zip | 34243-6223
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Country | US
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Telephone | 941-355-0303
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Fax | 941-554-7445
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PATRICIA LYNN HOLLOWAY
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Credential | NHA
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Telephone | 941-355-0303
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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 | 11835
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License Number State | FL
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