MEDICARE: RED STONE MANOR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility		FL

General Provider Information

NPI Number	:	1730695867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED STONE MANOR LLC

Provider Business Mailing Address
First Line	:	22 REGAL DR
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10804-1202
Country	:	US
Telephone Number	:	914-548-7617
Fax Number	:	914-633-1620

Provider Business Practice Location Address
First Line	:	1595 NE 145TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-3024
Country	:	US
Telephone Number	:	914-548-7617
Fax Number	:	914-633-1620

Authorized Official
Title or Position	:	MANAGER
Name	:	STEVEN BICKY
Credential	:
Telephone Number	:	914-548-7617

Provider Enumeration Date	:	12/27/2017
Last Update Date	:	12/27/2017

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Directions to “RED STONE MANOR LLC ” Practice Location

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