Provider Demographics
NPI:1598101875
Name:SANTOS, MIRTHA D
Entity Type:Organization
Organization Name:SANTOS, MIRTHA D
Other - Org Name:MIRTHA DSANTOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRTHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-862-9202
Mailing Address - Street 1:3220 CHADWICK RD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6007
Mailing Address - Country:US
Mailing Address - Phone:407-862-9202
Mailing Address - Fax:
Practice Address - Street 1:3220 CHADWICK RD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6007
Practice Address - Country:US
Practice Address - Phone:407-862-9202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906462311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002219600Medicaid