Provider Demographics
NPI:1306216312
Name:SHARING FACILITY INC 2
Entity Type:Organization
Organization Name:SHARING FACILITY INC 2
Other - Org Name:SHARING FACILITY INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-370-6765
Mailing Address - Street 1:924 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-6491
Mailing Address - Country:US
Mailing Address - Phone:772-370-6765
Mailing Address - Fax:772-464-2112
Practice Address - Street 1:924 HIGH ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-6491
Practice Address - Country:US
Practice Address - Phone:772-370-6765
Practice Address - Fax:772-464-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12725310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679849796Medicaid