Provider Demographics
NPI:1508136284
Name:SDB HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:SDB HEALTH SERVICES, INC
Other - Org Name:CHAMPION HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-608-3838
Mailing Address - Street 1:1370 SARNO RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5230
Mailing Address - Country:US
Mailing Address - Phone:321-608-3838
Mailing Address - Fax:321-286-5808
Practice Address - Street 1:1370 SARNO RD
Practice Address - Street 2:SUITE C
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5230
Practice Address - Country:US
Practice Address - Phone:321-608-3838
Practice Address - Fax:321-286-5808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211491251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNR# 30211491OtherAHCA