Provider Demographics
NPI:1710854344
Name:SANCTUARY AT LAKE DANIELS LLC
Entity type:Organization
Organization Name:SANCTUARY AT LAKE DANIELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-391-9028
Mailing Address - Street 1:1405 GARLAND DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8609
Mailing Address - Country:US
Mailing Address - Phone:951-391-9028
Mailing Address - Fax:
Practice Address - Street 1:1405 GARLAND DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8609
Practice Address - Country:US
Practice Address - Phone:951-391-9028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-20
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty