Provider Demographics
NPI:1275297749
Name:SOUTH SEAS ALF CARE LLC DBA SOUTH SEAS ALF
Entity Type:Organization
Organization Name:SOUTH SEAS ALF CARE LLC DBA SOUTH SEAS ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRINNELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-902-7977
Mailing Address - Street 1:101 MCABEE CT
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4756
Mailing Address - Country:US
Mailing Address - Phone:850-934-1061
Mailing Address - Fax:850-934-6932
Practice Address - Street 1:101 MCABEE CT
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4756
Practice Address - Country:US
Practice Address - Phone:850-934-1061
Practice Address - Fax:850-934-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility