1982918637 NPI number — SENIORBRIDGE FAMILY COMPANIES (FL), INC.

Table of content: (NPI 1982918637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982918637 NPI number — SENIORBRIDGE FAMILY COMPANIES (FL), INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENIORBRIDGE FAMILY COMPANIES (FL), INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982918637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
845 3RD AVE FL 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10022-6629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-994-6100
Provider Business Mailing Address Fax Number:
212-994-4260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1751 MOUND ST
Provider Second Line Business Practice Location Address:
UNIT G 100
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34236-7763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-366-0866
Provider Business Practice Location Address Fax Number:
941-366-0681
Provider Enumeration Date:
08/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RACKOW
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
212-994-6108

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  208080961 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 208080961 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 014191500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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