Healthcare Provider Details

I. General information

NPI: 1982045753
Provider Name (Legal Business Name): SWAN AT LAKE CONWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3714 SAINT MORITZ ST
BELLE ISLE FL
32812-1135
US

IV. Provider business mailing address

3714 SAINT MORITZ ST
BELLE ISLE FL
32812-1135
US

V. Phone/Fax

Practice location:
  • Phone: 407-860-0266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number11542
License Number StateFL

VIII. Authorized Official

Name: ASTER WORKU BATI
Title or Position: OWNER
Credential:
Phone: 407-860-0266