1001 Old Tomoka LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

12175 Issued in FL

Legal business name

1001 OLD TOMOKA LLC

Doing business as

The Sarah House III

Practice address

1001 Old Tomoka Rd
Ormond Beach, FL 32174-5979

Phone

(386) 453-1519

NPI assigned

Jan 2, 2014

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

Administrator

Phone

(386) 453-1519

Specialties & licenses 1

Addresses

Other names 1

• The Sarah House III Doing business as

Tax ID family

1001 Old Tomoka LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 1001 Old Tomoka LLC

  • Assisted Living Facility
  • Ormond Beach, FL
  • NPI 1942630462
  NPD tax ID

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

{
    "created_epoch": "1388620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654819200000",
    "number": "1538580923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 OLD TOMOKA RD",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321745979",
            "telephone_number": "386-453-1519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 OLD TOMOKA RD",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321745979",
            "telephone_number": "386-453-1519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1001 OLD TOMOKA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-02",
        "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": "ADMINISTRATOR",
        "authorized_official_telephone_number": "386-453-1519"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "12175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Sarah House III",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 1001 Old Tomoka LLC
• 1724 Valencia, LLC (The Sarah House II)
• 30 Forest CT, LLC (Sarah House IV (The))
• A Healthy Place PA
• A1 Imaging Centers LLC (Horizon Ormond Beach)

• 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.