MEDICARE: SHERBY DEVELOPMENT INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)	AL5672	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568582617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERBY DEVELOPMENT INC.

Provider Business Mailing Address
First Line	:	PO BOX 221650
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33022-1650
Country	:	US
Telephone Number	:	954-922-1995
Fax Number	:	954-923-1766

Provider Business Practice Location Address
First Line	:	2144 LINCOLN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-3917
Country	:	US
Telephone Number	:	954-922-1995
Fax Number	:	954-923-1766

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. LARRY SHERBERG
Credential	:
Telephone Number	:	954-922-1995

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	08/22/2020

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