NPIMap

Organization Active NPI

Excelsior Omega Inc.

Doing business as brisiana manor

  • Assisted Living Facility
  • Sarasota, FL
National Provider Identifier
1780825489
Registry record updated Sep 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL11449 Issued in FL
Legal business name
EXCELSIOR OMEGA INC.
Doing business as
brisiana manor
Practice address
15 Dade Ave
16 St Lucie Ave
Sarasota, FL 34232-1608
Phone
(941) 371-4091
NPI assigned
Mar 10, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2016

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

Authorized official

Name
Jacqueline St Juste
Title
Medicaide Eligible
Phone
(941) 371-4096

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL11449 FL Primary

Addresses

Primary practice location

15 Dade Ave
16 St Lucie Ave
Sarasota, FL 34232-1608

Mailing address

15 Dade Ave
Sarasota, FL 34232-1608
Phone (941) 371-4091

Other names 1

  • brisiana manor Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Excelsior Omega Inc2 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.

NPI Registry JSON

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

{
    "created_epoch": "1236643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474934400000",
    "number": "1780825489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 DADE AVE",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342321608",
            "telephone_number": "941-371-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 DADE AVE",
            "address_2": "16 ST LUCIE AVE",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342321608",
            "telephone_number": "941-371-4091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELSIOR OMEGA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-10",
        "last_updated": "2016-09-27",
        "status": "A",
        "authorized_official_last_name": "ST JUSTE",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "MEDICAIDE ELIGIBLE",
        "authorized_official_telephone_number": "941-371-4096"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "brisiana manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sarasota, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; 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.