Organization
EXCELSIOR OMEGA INC.
Active
Other names
brisiana manor
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE ST JUSTE (MEDICAIDE ELIGIBLE)
(941) 371-4096
Entity
Organization
Contact information
Practice address
15 DADE AVE, 16 ST LUCIE AVE, SARASOTA, FL 34232-1608
(941) 371-4091
Mailing address
15 DADE AVE, SARASOTA, FL 34232-1608
(941) 371-4091
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL11449
FL
Other
Enumeration date
03/10/2009
Last updated
09/27/2016
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