Provider Demographics
NPI:1609114164
Name:SEBASTIAN HOSPITAL LLC
Entity Type:Organization
Organization Name:SEBASTIAN HOSPITAL LLC
Other - Org Name:SEBASTIAN RIVER MEDICAL CENTER SNU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND C.E.O.
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-589-3164
Mailing Address - Street 1:13695 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3230
Mailing Address - Country:US
Mailing Address - Phone:772-589-3186
Mailing Address - Fax:772-388-3689
Practice Address - Street 1:13695 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3230
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:2013-01-17
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4375314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility