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General NPI Number Information
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NPI Number | 1699215699
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Entity Type | Organization
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Legal Business Name | SEA BREEZE ADULT DAY CENTER, LLC
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 618 94TH AVE N
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City | ST. PETERSBURG
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State | FL
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Zip | 33702-2408
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Country | US
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Telephone | 727-623-9092
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Fax |
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Provider Business Mailing Address
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Address Line | 618 94TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33702-2408
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Country | US
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Telephone | 727-623-9092
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MRS. NATALIE LEMKE
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Credential |
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Telephone | 727-623-9092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 9379
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License Number State | FL
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