Provider Demographics
NPI:1760857197
Name:SHERON FRATER
Entity Type:Organization
Organization Name:SHERON FRATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERON
Authorized Official - Middle Name:CARMELETA
Authorized Official - Last Name:FRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-345-5688
Mailing Address - Street 1:1041 PEMBROKE AVE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1310
Mailing Address - Country:US
Mailing Address - Phone:321-345-5688
Mailing Address - Fax:321-327-3311
Practice Address - Street 1:1041 PEMBROKE AVE NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1310
Practice Address - Country:US
Practice Address - Phone:321-345-5688
Practice Address - Fax:321-327-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No251E00000XAgenciesHome Health