Provider Demographics
NPI:1255674032
Name:SAN ENTERPRISES, INC.
Entity Type:Organization
Organization Name:SAN ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:AKTON
Authorized Official - Last Name:BENWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-375-9072
Mailing Address - Street 1:6742 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 259
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3321
Mailing Address - Country:US
Mailing Address - Phone:410-375-9072
Mailing Address - Fax:
Practice Address - Street 1:8047 45TH WAY N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33418-6170
Practice Address - Country:US
Practice Address - Phone:410-475-9072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-31
Last Update Date:2013-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2054584305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service