MEDICARE: SARG PORT ORANGE ALF LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3104A0625X	Assisted Living Facility (Mental Illness)
2	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
3	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1841063963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARG PORT ORANGE ALF LLC

Provider Business Mailing Address
First Line	:	3449 FERNLAKE PL
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32779-3201
Country	:	US
Telephone Number	:	407-797-4996
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 ORANGE AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4444
Country	:	US
Telephone Number	:	407-797-4996
Fax Number	:

Authorized Official
Title or Position	:	CEO & OWNER
Name	:	SAMIP JAYANTILAL BORAD
Credential	:	MD, MHA
Telephone Number	:	407-797-4996

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	10/31/2023

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Directions to “SARG PORT ORANGE ALF LLC ” Practice Location

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