Healthcare Provider Details

I. General information

NPI: 1659607463
Provider Name (Legal Business Name): MF HALIFAX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32117-4594
US

IV. Provider business mailing address

820 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32117-4594
US

V. Phone/Fax

Practice location:
  • Phone: 386-274-4575
  • Fax:
Mailing address:
  • Phone: 386-274-4575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIC ROTH
Title or Position: PRESIDENT
Credential:
Phone: 914-390-4377