Organization
FOUR SEASONS ALF DBA SANFORD MANOR ALF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARVIZ CARLOS (ADMINISTRATOR)
(407) 322-3321
Entity
Organization
Contact information
Practice address
1704 W 9TH ST, SANFORD, FL 32771-2381
(407) 322-3321
(407) 322-3324
Mailing address
1704 W 9TH ST, SANFORD, FL 32771-2381
(407) 322-3321
(407) 322-3324
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
AL4789
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000390200
—
FL
05
—
000390700
—
FL
Enumeration date
09/20/2010
Last updated
09/20/2010
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