Healthcare Provider Details

I. General information

NPI: 1407147614
Provider Name (Legal Business Name): MONTICELLO HLTH MGMT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 N JEFFERSON HWY
MONTICELLO FL
32344-5536
US

IV. Provider business mailing address

5000 N OCEAN BLVD SUITE 1104
LAUDERDALE BY THE SEA FL
33308-2929
US

V. Phone/Fax

Practice location:
  • Phone: 850-997-2313
  • Fax: 850-997-0218
Mailing address:
  • Phone: 404-456-9926
  • Fax: 954-367-4564

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: MARGARET HUDSON FERNANDEZ
Title or Position: CFO
Credential:
Phone: 954-367-4563