MEDICARE: SUSIES HOME 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	310400000X	Assisted Living Facility	AL12354	FL

General Provider Information

NPI Number	:	1700221959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSIES HOME LLC

Provider Business Mailing Address
First Line	:	28B KARAT PATH
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5670
Country	:	US
Telephone Number	:	386-437-3131
Fax Number	:	386-437-3131

Provider Business Practice Location Address
First Line	:	28B KARAT PATH
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5670
Country	:	US
Telephone Number	:	386-437-3131
Fax Number	:	386-437-3131

Authorized Official
Title or Position	:	CEO
Name	:	MR. JUNICHI OBAMA
Credential	:
Telephone Number	:	386-437-3131

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	05/22/2013

Similar Medicare Providers

1023668415 — BARBARA'S SUNNY DAY II, LLC
Practice Location Address:

3927 BUTTERCUP CIR S
PALM BEACH GARDENS, FL
33410-5670

Practice Phone: 561-612-7953
Practice Fax: 561-355-5653

1295510923 — SERENITY LIVING HOME CARE LLC
Practice Location Address:

3927 BUTTERCUP CIR S
PALM BEACH GARDENS, FL
33410-5670

Practice Phone: 407-219-8055
Practice Fax:

1962165217 — STEPHANIE SCHAGRIN APRN
Practice Location Address:

61 MEMORIAL MEDICAL PKWY STE 1-800A
PALM COAST, FL
32164-5983

Practice Phone: 386-302-1365
Practice Fax: 386-302-1366

1528940913 — MORGAN CHROBOT
Practice Location Address:

4 PINE BRANCH PL
PALM COAST, FL
32164-4830

Practice Phone: 386-627-5022
Practice Fax:

1336700558 — AMR KHALIFA MD
Practice Location Address:

60 MEMORIAL MEDICAL PKWY
PALM COAST, FL
32164-5980

Practice Phone: 386-586-1580
Practice Fax: 386-586-1563

1336007962 — MRS. LORI MARTIN APRN, FNP-BC, RN
Practice Location Address:

72 KASHMIR TRL
PALM COAST, FL
32164-5650

Practice Phone: 757-593-0406
Practice Fax:

Directions to “SUSIES HOME LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.