Provider Demographics
NPI:1780392860
Name:MANASOTA CARE SERVICES LLC
Entity type:Organization
Organization Name:MANASOTA CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEVTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYUJINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-780-6036
Mailing Address - Street 1:6712 THE MASTERS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2552
Mailing Address - Country:US
Mailing Address - Phone:941-780-6036
Mailing Address - Fax:
Practice Address - Street 1:6712 THE MASTERS AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2552
Practice Address - Country:US
Practice Address - Phone:941-780-6036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty