Sa-PG-Clearwater LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1407096 Issued in FL

Legal business name

SA-PG-CLEARWATER LLC

Doing business as

Palm Garden of Clearwater

Practice address

3480 N McMullen Booth Rd
Clearwater, FL 33761-1421

Phone

(727) 786-6697

Fax

(727) 781-0516

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 identifiers 1

Other names 1

• Palm Garden of Clearwater Doing business as

Tax ID family

Palm Garden of Clearwater2 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.

• Palm Garden of Clearwater LLC

  • Skilled Nursing Facility
  • Clearwater, FL
  • NPI 1457786410
  NPD tax ID

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1750387965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3480 MCMULLEN BOOTH ROAD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "33761",
            "telephone_number": "727-786-6697",
            "fax_number": "727-781-0516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3480 N MCMULLEN BOOTH RD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337611421",
            "telephone_number": "727-786-6697",
            "fax_number": "727-781-0516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SA-PG-CLEARWATER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2008-07-22",
        "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": "SNF1407096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025746000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palm Garden of Clearwater",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mallory Ryan, PT, DPT
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• Jalina Noelle Sabatose, PA-C
• Farida Sabet, APRN
• Michael D Saccente, D.O.

• Skilled Nursing Facility in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.