=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356743983
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M&A OF SARASOTA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2014
-----------------------------------------------------
Last Update Date | 09/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3548 SEA VIEW ST
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-923-0484
-----------------------------------------------------
Fax | 941-923-0484
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3548 SEA VIEW ST
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-923-0484
-----------------------------------------------------
Fax | 941-923-0484
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARGIT SZEL GERANE
-----------------------------------------------------
Credential | ADMINISTRATOR
-----------------------------------------------------
Telephone | 941-923-0484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 12162
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------