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General NPI Number Information
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NPI Number | 1568764371
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Entity Type | Organization
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Legal Business Name | SANDY LEMKE SUPPORTED LIVING SERVICES, INC.
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 735 38TH AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33705-3837
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Country | US
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Telephone | 727-823-9160
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Fax | 727-824-8841
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Provider Business Mailing Address
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Address Line | PO BOX 16521
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City | ST PETERSBURG
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State | FL
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Zip | 33733-6521
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Country | US
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Telephone | 727-823-9160
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Fax | 727-824-8841
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SANDRA ANN LEMKE
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Credential |
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Telephone | 727-823-9160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | FL
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