Provider Demographics
NPI:1164820353
Name:SANZELL GROUP HOME SERVICES INC
Entity Type:Organization
Organization Name:SANZELL GROUP HOME SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARREL
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:SANZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-667-4958
Mailing Address - Street 1:12360 66TH ST
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-3434
Mailing Address - Country:US
Mailing Address - Phone:727-667-4958
Mailing Address - Fax:727-754-6490
Practice Address - Street 1:12360 66TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-3434
Practice Address - Country:US
Practice Address - Phone:727-667-4958
Practice Address - Fax:727-754-6490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-20
Last Update Date:2014-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency