Provider Demographics
NPI:1447559570
Name:SAND LAKE REHAB & WELLNESS CENTER INC
Entity Type:Organization
Organization Name:SAND LAKE REHAB & WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERADIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-704-5518
Mailing Address - Street 1:1650 SAND LAKE RD
Mailing Address - Street 2:STE. 255
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7681
Mailing Address - Country:US
Mailing Address - Phone:407-704-5518
Mailing Address - Fax:407-704-5526
Practice Address - Street 1:1650 SAND LAKE RD
Practice Address - Street 2:STE. 255
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7681
Practice Address - Country:US
Practice Address - Phone:407-704-5518
Practice Address - Fax:407-704-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9064261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center