Provider Demographics
NPI:1134296924
Name:SUNLAND CENTER MARIANNA
Entity Type:Organization
Organization Name:SUNLAND CENTER MARIANNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL ASSISTANT II
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:H
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-482-9225
Mailing Address - Street 1:3700 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-7973
Mailing Address - Country:US
Mailing Address - Phone:850-482-9225
Mailing Address - Fax:850-718-0434
Practice Address - Street 1:3700 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-7973
Practice Address - Country:US
Practice Address - Phone:850-482-9225
Practice Address - Fax:850-718-0434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4079096315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities