Provider Demographics
NPI:1699191460
Name:STANDARD HOME LLC
Entity Type:Organization
Organization Name:STANDARD HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESARDIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-299-0390
Mailing Address - Street 1:3 E NIGHTINGALE ST
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2709
Mailing Address - Country:US
Mailing Address - Phone:407-464-0039
Mailing Address - Fax:
Practice Address - Street 1:3 E NIGHTINGALE ST
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2709
Practice Address - Country:US
Practice Address - Phone:407-464-0039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12147310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility