Healthcare Provider Details

I. General information

NPI: 1205176518
Provider Name (Legal Business Name): JULIES RETIREMENT RESORT INC 4
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 HIAWASSEE OAK DR
ORANGE FL
32818
US

IV. Provider business mailing address

7000 HIAWASSEE OAK DR
ORANGE FL
32818
US

V. Phone/Fax

Practice location:
  • Phone: 407-299-4290
  • Fax:
Mailing address:
  • Phone: 407-299-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number10663
License Number StateFL

VIII. Authorized Official

Name: RADIKA SINGH
Title or Position: OWNER
Credential:
Phone: 407-299-4290