Provider Demographics
NPI:1407461460
Name:SRE ASL SG, LLC
Entity Type:Organization
Organization Name:SRE ASL SG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-244-9173
Mailing Address - Street 1:2654 RED CLIFFS DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5827
Mailing Address - Country:US
Mailing Address - Phone:435-688-1622
Mailing Address - Fax:435-986-1228
Practice Address - Street 1:2654 RED CLIFFS DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5827
Practice Address - Country:US
Practice Address - Phone:435-688-1622
Practice Address - Fax:435-986-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility