Provider Demographics
NPI:1740470780
Name:SUN COAST RESIDENTIAL CARE, INC
Entity type:Organization
Organization Name:SUN COAST RESIDENTIAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTHRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-458-3770
Mailing Address - Street 1:813 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6811
Mailing Address - Country:US
Mailing Address - Phone:954-458-3770
Mailing Address - Fax:954-458-7370
Practice Address - Street 1:813 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6811
Practice Address - Country:US
Practice Address - Phone:954-458-3770
Practice Address - Fax:954-458-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9856310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility