Provider Demographics
NPI:1497195945
Name:SLC OF SORRENTO, INC
Entity Type:Organization
Organization Name:SLC OF SORRENTO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NAJDENKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DJORDJEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-966-5883
Mailing Address - Street 1:336 MONET DR
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-1357
Mailing Address - Country:US
Mailing Address - Phone:941-966-5883
Mailing Address - Fax:
Practice Address - Street 1:336 MONET DR
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-1357
Practice Address - Country:US
Practice Address - Phone:941-966-5883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7538310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility