Provider Demographics
NPI:1366786337
Name:S.A.A. GROUP HOME LLC
Entity type:Organization
Organization Name:S.A.A. GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:ANA
Authorized Official - Last Name:ARMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-394-9364
Mailing Address - Street 1:18137 PORTSIDE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3310
Mailing Address - Country:US
Mailing Address - Phone:813-394-9364
Mailing Address - Fax:813-907-5198
Practice Address - Street 1:18212 SALTWATER RUN PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3531
Practice Address - Country:US
Practice Address - Phone:813-991-9204
Practice Address - Fax:813-907-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32074GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health