MEDICARE: SSBP MANAGEMENT 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

General Provider Information

NPI Number	:	1760297469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SSBP MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	763 MUSGRASS CIR
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-8180
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1970 FARRINGTON DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-5532
Country	:	US
Telephone Number	:	321-594-0924
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	SATYAM SHARMA
Credential	:
Telephone Number	:	801-688-1680

Provider Enumeration Date	:	02/10/2025
Last Update Date	:	04/09/2025

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