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General NPI Number Information
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NPI Number | 1871926295
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Entity Type | Organization
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Legal Business Name | SANDRA ADULT FAMILY CARE HOME
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 1004 LARWOOD PINE DR
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City | RUSKIN
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State | FL
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Zip | 33570-5334
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Country | US
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Telephone | 813-476-8875
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 LARWOOD PINE DR
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City | RUSKIN
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State | FL
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Zip | 33570-5334
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Country | US
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Telephone | 813-476-8875
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SANDRA M SALOMON
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Credential |
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Telephone | 813-476-8875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6906469
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License Number State | FL
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