Provider Demographics
NPI:1902386733
Name:SONATA VERO BEACH LLC
Entity Type:Organization
Organization Name:SONATA VERO BEACH LLC
Other - Org Name:SONATA VERO BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-770-2401
Mailing Address - Street 1:2425 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6615
Mailing Address - Country:US
Mailing Address - Phone:772-770-2401
Mailing Address - Fax:772-770-0313
Practice Address - Street 1:2425 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6615
Practice Address - Country:US
Practice Address - Phone:772-770-2401
Practice Address - Fax:772-770-0313
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S-H THIRTY-FIVE OPCO - VERO BEACH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20-8672070Medicaid