MEDICARE: SEBASTIAN HOSPITAL LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1679516678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEBASTIAN HOSPITAL LLC

Provider Business Mailing Address
First Line	:	13695 US HIGHWAY 1
Second Line	:
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-3230
Country	:	US
Telephone Number	:	772-581-3181
Fax Number	:	772-663-9676

Provider Business Practice Location Address
First Line	:	8000 RON BEATTY BLVD
Second Line	:
City	:	BAREFOOT BAY
State	:	FL
Zip	:	32976-7474
Country	:	US
Telephone Number	:	772-589-3186
Fax Number	:	772-388-3689

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	LAURIE J HOLTSFORD
Credential	:
Telephone Number	:	615-465-7466

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	03/04/2014

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