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General NPI Number Information
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NPI Number | 1790122505
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Entity Type | Organization
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Legal Business Name | SAMS ASSISTED LIVING FACILTY INC #2
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 11 COTTAGEGATE CT
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City | PALM COAST
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State | FL
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Zip | 32137-8964
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Country | US
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Telephone | 386-627-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 11 COTTAGEGATE CT
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City | PALM COAST
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State | FL
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Zip | 32137-8964
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Country | US
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Telephone | 386-627-3800
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MARIA L PANILAG
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Credential |
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Telephone | 386-627-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | AL10049
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License Number State | FL
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