Provider Demographics
NPI:1902214018
Name:SABRENA'S RETIREMENT RESORT INC. 4
Entity Type:Organization
Organization Name:SABRENA'S RETIREMENT RESORT INC. 4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUKHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMAROO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-293-6800
Mailing Address - Street 1:7000 HIAWASSEE OAK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8354
Mailing Address - Country:US
Mailing Address - Phone:407-299-4290
Mailing Address - Fax:407-294-4728
Practice Address - Street 1:7000 HIAWASSEE OAK DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-8354
Practice Address - Country:US
Practice Address - Phone:407-299-4290
Practice Address - Fax:407-294-4728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10663305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization