30 Forest CT, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12649 Issued in FL

Legal business name

30 FOREST CT, LLC

Doing business as

Sarah House IV (The)

Practice address

30 Forest CT
Ormond Beach, FL 32174-8471

Phone

(386) 872-7797

Fax

(877) 473-1219

NPI assigned

Apr 23, 2015

Last updated

Jun 10, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shoshana Sharon

Title

Owner

Phone

(386) 872-7871

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sarah House IV (The) Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654819200000",
    "number": "1336536754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 FOREST CT",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321748471",
            "telephone_number": "386-872-7797",
            "fax_number": "877-473-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 FOREST CT",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321748471",
            "telephone_number": "386-872-7797",
            "fax_number": "877-473-1219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "30 FOREST CT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-23",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A",
        "authorized_official_last_name": "SHARON",
        "authorized_official_first_name": "SHOSHANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-872-7871"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA LICENSE",
            "identifier": "AL12649",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sarah House IV (The)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sarah House IV (The)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 1001 Old Tomoka LLC (The Sarah House III)
• 1001 Old Tomoka LLC
• 1724 Valencia, LLC (The Sarah House II)
• A Healthy Place PA
• A1 Imaging Centers LLC (Horizon Ormond Beach)
• A1 Imaging of Ormond Beach LLC (Horizon Ormond Beach)
• ABA Family Medicine, LLC
• Ibrahim Ahmed Abdalla Wafik, M.D.

• Assisted Living Facility in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.