Provider Demographics
NPI:1528052321
Name:PINES OF SARASOTA INC
Entity type:Organization
Organization Name:PINES OF SARASOTA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALF ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARBONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:941-365-0250
Mailing Address - Street 1:1501 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-2631
Mailing Address - Country:US
Mailing Address - Phone:941-365-0250
Mailing Address - Fax:941-365-4121
Practice Address - Street 1:1501 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-2631
Practice Address - Country:US
Practice Address - Phone:941-365-0250
Practice Address - Fax:941-365-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7450310400000X
FLSNF1443095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
078311941OtherDUNS
FL020270300Medicaid
=========OtherFED TAX ID
FL105147Medicare Oscar/Certification