=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649450891
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARASOTA HOME HEALTH CARE AGENCY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2007
-----------------------------------------------------
Last Update Date | 01/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 456 S TAMIAMI TRAIL
-----------------------------------------------------
City | OSPREY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-306-4347
-----------------------------------------------------
Fax | 941-866-7539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 456 S TAMIAMI TRL
-----------------------------------------------------
City | OSPREY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34229-9206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-306-4347
-----------------------------------------------------
Fax | 941-866-7539
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | VICTOR VISHNEVSKY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 941-306-4347
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299993115
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------