Healthcare Provider Details

I. General information

NPI: 1861976342
Provider Name (Legal Business Name): DJMP MANAGEMENT FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 FOXTAIL CT
KISSIMMEE FL
34746-3305
US

IV. Provider business mailing address

4104 FOXTAIL CT
KISSIMMEE FL
34746-3305
US

V. Phone/Fax

Practice location:
  • Phone: 321-662-3408
  • Fax:
Mailing address:
  • Phone: 321-662-3408
  • 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: BEVERLY ANN BRYLOWSKI
Title or Position: VICE PRESIDENT
Credential:
Phone: 321-662-3408