MEDICARE: SONATA OSCEOLA MANAGERS, 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	:	1881237436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONATA OSCEOLA MANAGERS, LLC

Provider Business Mailing Address
First Line	:	1701 BALL PARK RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-1135
Country	:	US
Telephone Number	:	407-900-2840
Fax Number	:	407-870-0288

Provider Business Practice Location Address
First Line	:	1701 BALL PARK RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-1135
Country	:	US
Telephone Number	:	407-900-2840
Fax Number	:	407-870-0288

Authorized Official
Title or Position	:	REGIONAL DIRECTOR OF OPERATIONS
Name	:	AMY JOAN STEPHENSON
Credential	:
Telephone Number	:	352-216-2480

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	10/25/2019

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