MEDICARE: SANTA BARBARA SOCIAL CLUB 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	261QA0600X	Adult Day Care Clinic/Center

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	:	1821758285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA BARBARA SOCIAL CLUB LLC

Provider Business Mailing Address
First Line	:	9321 SW 174TH ST
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-5716
Country	:	US
Telephone Number	:	786-479-2000
Fax Number	:	239-842-6787

Provider Business Practice Location Address
First Line	:	2135 SANTA BARBARA BLVD STE 106-108
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-4359
Country	:	US
Telephone Number	:	239-984-2916
Fax Number	:	239-842-6787

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BORIS L. AVILA
Credential	:
Telephone Number	:	786-479-2000

Provider Enumeration Date	:	12/28/2021
Last Update Date	:	12/28/2021

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Directions to “SANTA BARBARA SOCIAL CLUB LLC ” Practice Location

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