Provider Demographics
NPI:1821758285
Name:SANTA BARBARA SOCIAL CLUB LLC
Entity Type:Organization
Organization Name:SANTA BARBARA SOCIAL CLUB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-479-2000
Mailing Address - Street 1:9321 SW 174TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5716
Mailing Address - Country:US
Mailing Address - Phone:786-479-2000
Mailing Address - Fax:239-842-6787
Practice Address - Street 1:2135 SANTA BARBARA BLVD STE 106-108
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-4359
Practice Address - Country:US
Practice Address - Phone:239-984-2916
Practice Address - Fax:239-842-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care