Provider Demographics
NPI:1770931214
Name:MICHELLE LARIVIERE D.B.A. SLC OF SORRENTO
Entity type:Organization
Organization Name:MICHELLE LARIVIERE D.B.A. SLC OF SORRENTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR LOWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LARIVIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-966-5883
Mailing Address - Street 1:336 MONET DRIVE
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-1357
Mailing Address - Country:US
Mailing Address - Phone:941-966-5883
Mailing Address - Fax:941-966-5883
Practice Address - Street 1:336 MONET DRIVE
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-1357
Practice Address - Country:US
Practice Address - Phone:941-966-5883
Practice Address - Fax:941-966-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility