Provider Demographics
NPI:1679021216
Name:SHERIDAN ASSISTED LIVING, INC
Entity Type:Organization
Organization Name:SHERIDAN ASSISTED LIVING, INC
Other - Org Name:SHERIDAN IN HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-993-0265
Mailing Address - Street 1:3710 ROBERTSON BLVD
Mailing Address - Street 2:216
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2350
Mailing Address - Country:US
Mailing Address - Phone:310-204-1187
Mailing Address - Fax:310-204-1218
Practice Address - Street 1:3710 ROBERTSON BLVD
Practice Address - Street 2:216
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2350
Practice Address - Country:US
Practice Address - Phone:310-204-1187
Practice Address - Fax:310-204-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA194700194253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care