Organization
30 FOREST CT, LLC
Active
Other names
Sarah House IV (The)
Organization subpart
No
Provider details
NPI number
Authorized official
SHOSHANA SHARON (OWNER)
(386) 872-7871
Entity
Organization
Contact information
Practice address
30 FOREST CT, ORMOND BEACH, FL 32174-8471
(386) 872-7797
(877) 473-1219
Mailing address
30 FOREST CT, ORMOND BEACH, FL 32174-8471
(386) 872-7797
(877) 473-1219
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12649
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL12649
AHCA LICENSE
FL
Enumeration date
04/23/2015
Last updated
06/10/2022
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