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General NPI Number Information
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NPI Number | 1841855822
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Entity Type | Organization
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Legal Business Name | SHIFTING SANDS ADULT DAY CENTER, LLC
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 28410 BONITA CROSSINGS BLVD UNIT 7
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-3211
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Country | US
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Telephone | 239-405-7009
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Fax |
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Provider Business Mailing Address
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Address Line | 28410 BONITA CROSSINGS BLVD UNIT 7
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-3211
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Country | US
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Telephone | 239-777-3422
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TAMMY WILKINSON
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Credential | RN
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Telephone | 239-405-7009
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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 |
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License Number State |
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