Provider Demographics
NPI:1316194988
Name:TED SLONE,LLC
Entity Type:Organization
Organization Name:TED SLONE,LLC
Other - Org Name:SUGARMILL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODPASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-795-6929
Mailing Address - Street 1:1122 SE KINGS BAY DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4645
Mailing Address - Country:US
Mailing Address - Phone:352-795-6929
Mailing Address - Fax:
Practice Address - Street 1:8303 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-5028
Practice Address - Country:US
Practice Address - Phone:352-795-6929
Practice Address - Fax:352-794-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267384300Medicaid
FL291921400Medicaid
V3150OtherBLUE CROSS
FL267384300Medicaid
FL291921400Medicaid