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General NPI Number Information
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NPI Number | 1396902193
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Entity Type | Organization
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Legal Business Name | SUUNY DAYS ALF,INC
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 169 NE PRIMA VISTA BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-8462
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Country | US
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Telephone | 772-343-9088
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Fax | 772-343-9074
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Provider Business Mailing Address
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Address Line | 169 NE PRIMA VISTA BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-8462
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Country | US
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Telephone | 772-343-9088
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Fax | 772-343-9074
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. KELLY ANN POWERS SALVATO
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Credential | RN
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Telephone | 772-285-2466
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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 | AL9008
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License Number State | FL
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