Healthcare Provider Details

I. General information

NPI: 1982376133
Provider Name (Legal Business Name): BEDROCK HCS AT DAYTONA FL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 N WILLIAMSON BLVD
DAYTONA BEACH FL
32114-7185
US

IV. Provider business mailing address

1776 AVENUE OF THE STATES STE 302
LAKEWOOD NJ
08701-4592
US

V. Phone/Fax

Practice location:
  • Phone: 386-257-4400
  • Fax:
Mailing address:
  • Phone: 732-328-7499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ESTHER TILLIM
Title or Position: BOOKEEPER
Credential:
Phone: 732-328-7499