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General NPI Number Information
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NPI Number | 1609114164
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Entity Type | Organization
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Legal Business Name | SEBASTIAN HOSPITAL LLC
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | 13695 US HIGHWAY 1
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City | SEBASTIAN
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State | FL
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Zip | 32958-3230
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Country | US
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Telephone | 772-589-3186
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Fax | 772-388-3689
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Provider Business Mailing Address
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Address Line | 13695 US HIGHWAY 1
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City | SEBASTIAN
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State | FL
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Zip | 32958-3230
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Country | US
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Telephone | 772-589-3186
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Fax | 772-388-3689
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Authorized Official
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Title or Position | PRESIDENT AND C.E.O.
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Name | MS. KELLY ENRIQUEZ
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Credential |
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Telephone | 772-589-3164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 4375
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License Number State | FL
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