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General NPI Number Information
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NPI Number | 1306436159
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Entity Type | Organization
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Legal Business Name | A SUNCOAST LIFE, INC.
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 1100 E BAY DR # G-78
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City | LARGO
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State | FL
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Zip | 33770-2541
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Country | US
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Telephone | 239-888-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 E BAY DR # G-78
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City | LARGO
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State | FL
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Zip | 33770-2541
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Country | US
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Telephone | 239-888-3111
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | JOHNATHAN ERIC FOURTHMAN
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Credential |
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Telephone | 239-888-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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