Provider Demographics
NPI:1003469255
Name:SAND DOLLAR INDUSTRIES, INC
Entity Type:Organization
Organization Name:SAND DOLLAR INDUSTRIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JERI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-323-6323
Mailing Address - Street 1:905 E MARTIN LUTHER KING JR DR STE 330
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-4853
Mailing Address - Country:US
Mailing Address - Phone:727-935-1948
Mailing Address - Fax:727-935-2082
Practice Address - Street 1:905 E MARTIN LUTHER KING JR DR STE 330
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4853
Practice Address - Country:US
Practice Address - Phone:727-935-1948
Practice Address - Fax:727-935-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health