Sa-Clewiston, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1092096 Issued in FL

Legal business name

SA-CLEWISTON, LLC

Doing business as

Palm Terrace of Clewiston

Practice address

301 S Gloria St
Clewiston, FL 33440-3520

Phone

(863) 983-5123

Fax

(863) 983-6698

NPI assigned

Jun 22, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Alex Paley

Title

Coo

Phone

(914) 390-4363

Specialties & licenses 1

Addresses

Other names 1

• Palm Terrace of Clewiston Doing business as

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202428800000",
    "number": "1679579965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 S GLORIA ST",
            "city": "CLEWISTON",
            "state": "FL",
            "postal_code": "334403520",
            "telephone_number": "863-983-5123",
            "fax_number": "863-983-6698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S GLORIA ST",
            "city": "CLEWISTON",
            "state": "FL",
            "postal_code": "334403520",
            "telephone_number": "863-983-5123",
            "fax_number": "863-983-6698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SA-CLEWISTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2008-02-08",
        "status": "A",
        "authorized_official_last_name": "PALEY",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "914-390-4363",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1092096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palm Terrace of Clewiston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2008; 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.