Provider Demographics
NPI:1790122505
Name:SAMS ASSISTED LIVING FACILTY INC #2
Entity Type:Organization
Organization Name:SAMS ASSISTED LIVING FACILTY INC #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PANILAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-627-3800
Mailing Address - Street 1:11 COTTAGEGATE CT
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8964
Mailing Address - Country:US
Mailing Address - Phone:386-627-3800
Mailing Address - Fax:
Practice Address - Street 1:11 COTTAGEGATE CT
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8964
Practice Address - Country:US
Practice Address - Phone:386-627-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10049251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health