Provider Demographics
NPI:1942605548
Name:SWAN S.P. ENTERPRISES
Entity Type:Organization
Organization Name:SWAN S.P. ENTERPRISES
Other - Org Name:PROMISE MANOR WELLCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-863-7481
Mailing Address - Street 1:45 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-6121
Mailing Address - Country:US
Mailing Address - Phone:561-863-7481
Mailing Address - Fax:
Practice Address - Street 1:45 W 17TH ST
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-6121
Practice Address - Country:US
Practice Address - Phone:561-863-7481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWAN S P ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health