Provider Demographics
NPI:1679065122
Name:PINES OF SARASOTA HEALTHCARE, LLC
Entity Type:Organization
Organization Name:PINES OF SARASOTA HEALTHCARE, LLC
Other - Org Name:PINES OF SARASOTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-365-0250
Mailing Address - Street 1:1501 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-2694
Mailing Address - Country:US
Mailing Address - Phone:941-365-0250
Mailing Address - Fax:
Practice Address - Street 1:1251 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236
Practice Address - Country:US
Practice Address - Phone:941-365-0250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7450310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL7450OtherSTATE OF FLORIDA AGENCY FOR HEALTHCARE ADMINISTRATION
FL116657100Medicaid