Provider Demographics
NPI:1205195492
Name:SOVRAN SENIOR LIVING LLC
Entity Type:Organization
Organization Name:SOVRAN SENIOR LIVING LLC
Other - Org Name:WARSAW HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MIS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORENE
Authorized Official - Middle Name:MARQUESS
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-659-4900
Mailing Address - Street 1:1400 CENTREPARK BLVD STE 810
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-7412
Mailing Address - Country:US
Mailing Address - Phone:239-659-4900
Mailing Address - Fax:239-963-3410
Practice Address - Street 1:214 LANEFIELD RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NC
Practice Address - Zip Code:28398
Practice Address - Country:US
Practice Address - Phone:910-293-3144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0418310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility