Organization Name: | SHARICKS DECK RETIREMENT RANCH |
NPI Number: | 1184853640 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NICOLAS ANTONIO CICCARELLO (OWNER) |
Mailing Address: | 4506 Bruton Rd Plant City |
State: | FL US |
Postal Code: | 335657029 |
Phone Number: | 8137545223 |
Fax Number: | 8137529265 |
NPI Enumeration Date: | 07/06/2009 |
NPI Last Update Date: | 06/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | AL5335 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |