Provider Demographics
NPI:1982106464
Name:SWEETWATER OAKS ASSISTED LIVING
Entity Type:Organization
Organization Name:SWEETWATER OAKS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASHID
Authorized Official - Middle Name:
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-779-3499
Mailing Address - Street 1:2820 PAN AMERICAN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287
Mailing Address - Country:US
Mailing Address - Phone:941-779-3499
Mailing Address - Fax:941-244-0704
Practice Address - Street 1:2820 PAN AMERICAN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287
Practice Address - Country:US
Practice Address - Phone:941-779-3499
Practice Address - Fax:941-244-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL13083310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherPRIVATE PAY