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General NPI Number Information
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NPI Number | 1770931214
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Entity Type | Organization
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Legal Business Name | MICHELLE LARIVIERE D.B.A. SLC OF SORRENTO
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 336 MONET DRIVE
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City | NOKOMIS
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State | FL
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Zip | 34275-1357
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Country | US
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Telephone | 941-966-5883
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Fax | 941-966-5883
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Provider Business Mailing Address
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Address Line | 336 MONET DRIVE
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City | NOKOMIS
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State | FL
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Zip | 34275-1357
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Country | US
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Telephone | 941-966-5883
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Fax | 941-966-5883
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Authorized Official
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Title or Position | ADMINISTRATOR LOWNER
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Name | MS. MICHELLE ANN LARIVIERE
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Credential |
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Telephone | 941-966-5883
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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 |
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License Number State | FL
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