Provider Demographics
NPI:1417650714
Name:SUNCOAST PALLIATIVE CARE AND WOUND HEALING, INC
Entity Type:Organization
Organization Name:SUNCOAST PALLIATIVE CARE AND WOUND HEALING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-957-8730
Mailing Address - Street 1:10335 CROSS CREEK BLVD # H20
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2795
Mailing Address - Country:US
Mailing Address - Phone:813-957-8730
Mailing Address - Fax:813-212-2824
Practice Address - Street 1:6719 GALL BLVD STE 203
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2569
Practice Address - Country:US
Practice Address - Phone:813-957-8730
Practice Address - Fax:813-212-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty