Provider Demographics
NPI:1407220338
Name:SORENSEN & SMITH LLC
Entity Type:Organization
Organization Name:SORENSEN & SMITH LLC
Other - Org Name:RIVERWOOD LODGE ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:0
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-497-2273
Mailing Address - Street 1:6873 SW US HWY 27
Mailing Address - Street 2:
Mailing Address - City:FORT WHITE
Mailing Address - State:FL
Mailing Address - Zip Code:32038
Mailing Address - Country:US
Mailing Address - Phone:386-497-2273
Mailing Address - Fax:
Practice Address - Street 1:6873 SW US HWY 27
Practice Address - Street 2:
Practice Address - City:FORT WHITE
Practice Address - State:FL
Practice Address - Zip Code:32038
Practice Address - Country:US
Practice Address - Phone:386-497-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12714310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility