Provider Demographics
NPI:1083170534
Name:SF BREVARD, LLC
Entity Type:Organization
Organization Name:SF BREVARD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-430-0000
Mailing Address - Street 1:298 SW PROSPERITY PLACE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024
Mailing Address - Country:US
Mailing Address - Phone:833-623-3093
Mailing Address - Fax:833-623-3093
Practice Address - Street 1:298 SW PROSPERITY PLACE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024
Practice Address - Country:US
Practice Address - Phone:833-623-3093
Practice Address - Fax:833-623-3093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA FACILITIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility