Provider Demographics
NPI:1053560680
Name:SWEET RETREAT ASSISTED LIVING FACILITY
Entity type:Organization
Organization Name:SWEET RETREAT ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SEBASTIAN
Authorized Official - Last Name:WEBBE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-476-5893
Mailing Address - Street 1:142 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-3629
Mailing Address - Country:US
Mailing Address - Phone:904-354-3805
Mailing Address - Fax:904-354-3875
Practice Address - Street 1:142 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-3629
Practice Address - Country:US
Practice Address - Phone:904-354-3805
Practice Address - Fax:904-354-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11394310400000X, 3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness