Provider Demographics
NPI:1306021837
Name:SURE
Entity Type:Organization
Organization Name:SURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LASHUN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-404-5618
Mailing Address - Street 1:1703 E 26TH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-1180
Mailing Address - Country:US
Mailing Address - Phone:813-404-5618
Mailing Address - Fax:813-247-1421
Practice Address - Street 1:1703 E 26TH AVE UNIT B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-1180
Practice Address - Country:US
Practice Address - Phone:813-404-5618
Practice Address - Fax:813-247-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL229966251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693164298Medicaid
FL693164296Medicaid