Provider Demographics
NPI:1356644983
Name:BETTY JEAN SADLER
Entity Type:Organization
Organization Name:BETTY JEAN SADLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORTED LIVING
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-271-1262
Mailing Address - Street 1:800 E PINE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4371
Mailing Address - Country:US
Mailing Address - Phone:850-271-1262
Mailing Address - Fax:850-265-6995
Practice Address - Street 1:800 E PINE FOREST DR
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4371
Practice Address - Country:US
Practice Address - Phone:850-271-1262
Practice Address - Fax:850-265-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL678253196320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL678253198Medicaid