Provider Demographics
NPI:1235759846
Name:EMBASSY INDIAN OAKS LLC
Entity Type:Organization
Organization Name:EMBASSY INDIAN OAKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:REPCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-362-4753
Mailing Address - Street 1:240 N WASHINGTON BLVD STE 430
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5933
Mailing Address - Country:US
Mailing Address - Phone:941-362-4753
Mailing Address - Fax:941-362-4766
Practice Address - Street 1:11355 131ST ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-4716
Practice Address - Country:US
Practice Address - Phone:941-362-4753
Practice Address - Fax:941-362-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility