=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841594173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAND POINT SENIOR LIVING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2010
-----------------------------------------------------
Last Update Date | 12/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 HARRISON ST
-----------------------------------------------------
City | TITUSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32780-4695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-383-6000
-----------------------------------------------------
Fax | 321-267-6308
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 HARRISON ST
-----------------------------------------------------
City | TITUSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32780-4695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-383-6000
-----------------------------------------------------
Fax | 321-267-6308
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF SALES & MARKETING
-----------------------------------------------------
Name | MS. MONICA L PERAGINE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-383-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | AL5758
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------