Healthcare Provider Details

I. General information

NPI: 1174515654
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MASON AVE
DAYTONA BEACH FL
32117-5103
US

IV. Provider business mailing address

1920 MASON AVE
DAYTONA BEACH FL
32117-5103
US

V. Phone/Fax

Practice location:
  • Phone: 386-274-3460
  • Fax: 386-274-3487
Mailing address:
  • Phone: 386-274-3460
  • Fax: 386-274-3487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1143095
License Number StateFL

VIII. Authorized Official

Name: MISS CLAUDIA RENEE DAY
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 727-518-3202