Provider Demographics
NPI:1710978291
Name:SANDHILL COVE PROPERTIES INC.
Entity Type:Organization
Organization Name:SANDHILL COVE PROPERTIES INC.
Other - Org Name:WATER'S EDGE EXTENDED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, SECRETARY AND TREAS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRIEVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-875-4754
Mailing Address - Street 1:1500 SW CAPRI ST
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4518
Mailing Address - Country:US
Mailing Address - Phone:772-283-7775
Mailing Address - Fax:772-283-7092
Practice Address - Street 1:1500 SW CAPRI ST
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-4518
Practice Address - Country:US
Practice Address - Phone:772-283-7775
Practice Address - Fax:772-283-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1585096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012315200Medicaid
FL105828Medicare Oscar/Certification