Basic Information
| Provider Information | |||||||||
| NPI: | 1306290747 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SANDLAKE-ABILITY HEALTH SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 LEXINGTON GREEN LN | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327711013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076880070 | ||||||||
| FaxNumber: | 4076880071 | ||||||||
| Practice Location | |||||||||
| Address1: | 7940 VIA DELLAGIO WAY STE 142 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328195400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077454633 | ||||||||
| FaxNumber: | 4077454635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2016 | ||||||||
| LastUpdateDate: | 04/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | GUERRINA | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4076880070 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ABILITY HEALTH SERVICES INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | FL | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.