Provider Demographics
NPI:1902551245
Name:OCEAN BREEZE CARE LLC
Entity Type:Organization
Organization Name:OCEAN BREEZE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WAIVER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWABY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-448-0193
Mailing Address - Street 1:2380 TAMI SOLA ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-8042
Mailing Address - Country:US
Mailing Address - Phone:941-448-0193
Mailing Address - Fax:
Practice Address - Street 1:2380 TAMI SOLA ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-8042
Practice Address - Country:US
Practice Address - Phone:941-448-0193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities