Healthcare Provider Details

I. General information

NPI: 1669291563
Provider Name (Legal Business Name): ANSLEY COURT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W MAITLAND BLVD
MAITLAND FL
32751-4338
US

IV. Provider business mailing address

PO BOX 519
AUBURNDALE FL
33823-0519
US

V. Phone/Fax

Practice location:
  • Phone: 321-280-6286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SAVITRI JOHNSON
Title or Position: ADMINISTRATIVE ASSISTANT / AR
Credential:
Phone: 863-226-0358