Provider Demographics
NPI:1437198751
Name:SEBASTIAN HOSPITAL LLC
Entity Type:Organization
Organization Name:SEBASTIAN HOSPITAL LLC
Other - Org Name:SEBASTIAN RIVER HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:8000 RON BEATTY BLVD
Mailing Address - Street 2:SUITE A4
Mailing Address - City:BAREFOOT BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32976-7474
Mailing Address - Country:US
Mailing Address - Phone:772-589-3186
Mailing Address - Fax:772-388-3689
Practice Address - Street 1:8000 RON BEATTY BLVD
Practice Address - Street 2:SUITE A4
Practice Address - City:BAREFOOT BAY
Practice Address - State:FL
Practice Address - Zip Code:32976-7474
Practice Address - Country:US
Practice Address - Phone:772-589-3186
Practice Address - Fax:772-388-3689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJW3OtherBLUE CROSS
107744Medicare Oscar/Certification