Healthcare Provider Details

I. General information

NPI: 1124029871
Provider Name (Legal Business Name): MONTICELLO PARTNERSHIP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 N JEFFERSON
MONTICELLO FL
32344-5536
US

IV. Provider business mailing address

2851 REMINGTON GREEN CIR SUITE D
TALLAHASSEE FL
32308-1505
US

V. Phone/Fax

Practice location:
  • Phone: 850-997-2313
  • Fax: 850-997-0321
Mailing address:
  • Phone: 850-386-2522
  • Fax: 850-386-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOSEPH D. MITCHELL
Title or Position: PRESIDENT
Credential:
Phone: 850-386-2522