Provider Demographics
NPI:1447644653
Name:SANDRA CARES ADULT FAMILY CARE HOME, INC.
Entity type:Organization
Organization Name:SANDRA CARES ADULT FAMILY CARE HOME, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:JEANNOT
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:813-506-3907
Mailing Address - Street 1:4207 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616
Mailing Address - Country:US
Mailing Address - Phone:813-506-3907
Mailing Address - Fax:813-304-1869
Practice Address - Street 1:4207 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33616-1139
Practice Address - Country:US
Practice Address - Phone:813-506-3907
Practice Address - Fax:813-304-1869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906746311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home