Provider Demographics
NPI:1639822844
Name:GAINES SADLER, BETTY J
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:GAINES SADLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BETTY
Other - Middle Name:J
Other - Last Name:GAINES SADLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 E PINE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4371
Mailing Address - Country:US
Mailing Address - Phone:850-624-1767
Mailing Address - Fax:850-265-6995
Practice Address - Street 1:800 E PINE FOREST DR
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4371
Practice Address - Country:US
Practice Address - Phone:850-624-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 253Z00000X, 376K00000X, 251E00000X
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No174400000XOther Service ProvidersSpecialist
No253Z00000XAgenciesIn Home Supportive Care
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty