Organization
SANDY LEMKE SUPPORTED LIVING SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SANDRA ANN LEMKE (PRESIDENT)
(727) 823-9160
Entity
Organization
Contact information
Practice address
735 38TH AVE S, ST PETERSBURG, FL 33705-3837
(727) 823-9160
(727) 824-8841
Mailing address
PO BOX 16521, ST PETERSBURG, FL 33733-6521
(727) 823-9160
(727) 824-8841
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
672827801
MEDICAID DEVELOPMENTAL DISABILITIES FAMILY AND SUPPORTED LIVING WAIVER
FL
01
—
672827896
MEDICAID DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED WAIVER NUMBER
FL
Enumeration date
11/30/2010
Last updated
11/30/2010
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