Provider Demographics
NPI:1225579378
Name:SANDTON ENTERPRISES
Entity Type:Organization
Organization Name:SANDTON ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGEREM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-506-3137
Mailing Address - Street 1:10539 PARKCREST DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5023
Mailing Address - Country:US
Mailing Address - Phone:813-506-3137
Mailing Address - Fax:813-699-8307
Practice Address - Street 1:10539 PARKCREST DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5023
Practice Address - Country:US
Practice Address - Phone:813-506-3137
Practice Address - Fax:813-699-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234695253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690976196Medicaid