Healthcare Provider Details

I. General information

NPI: 1922246446
Provider Name (Legal Business Name): 1780 MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 N JEFFERSON
MONTICELLO FL
32344-5536
US

IV. Provider business mailing address

4700 SHERIDAN ST SUITE B
HOLLYWOOD FL
33021-3420
US

V. Phone/Fax

Practice location:
  • Phone: 850-997-2313
  • Fax: 850-997-0321
Mailing address:
  • Phone: 954-367-4563
  • Fax: 954-367-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MARGARET HUDSON FERNANDEZ
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 954-367-4563