Provider Demographics
NPI:1952708752
Name:SPRING PINE LLC
Entity Type:Organization
Organization Name:SPRING PINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VESNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKALAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-246-7484
Mailing Address - Street 1:1324 MILL SLOUGH RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2620
Mailing Address - Country:US
Mailing Address - Phone:321-246-7486
Mailing Address - Fax:407-870-7691
Practice Address - Street 1:1324 MILL SLOUGH RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2620
Practice Address - Country:US
Practice Address - Phone:321-246-7486
Practice Address - Fax:407-870-7691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12580310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility