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General NPI Number Information
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NPI Number | 1417445685
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Entity Type | Organization
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Legal Business Name | SUNNILAND ASSISTED LIVING FACILITY,LLC
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 4234 SUNNILAND ST
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City | SARASOTA
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State | FL
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Zip | 34233-1817
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Country | US
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Telephone | 941-921-3801
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Fax | 941-924-9783
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Provider Business Mailing Address
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Address Line | 4234 SUNNILAND ST
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City | SARASOTA
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State | FL
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Zip | 34233-1817
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Country | US
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Telephone | 941-921-3801
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Fax | 941-924-9783
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Authorized Official
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Title or Position | CFO
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Name | BENJAMIN WADE MOULTON
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Credential |
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Telephone | 941-921-3801
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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 | 8267
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License Number State | FL
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