Healthcare Provider Details

I. General information

NPI: 1912728759
Provider Name (Legal Business Name): IONIE'S ASSISTED LIVING II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 HAMMERSMITH RD
ORLANDO FL
32818-3073
US

IV. Provider business mailing address

3120 HAMMERSMITH RD
ORLANDO FL
32818-3073
US

V. Phone/Fax

Practice location:
  • Phone: 407-296-7163
  • Fax: 866-768-4105
Mailing address:
  • Phone: 407-296-7163
  • Fax: 866-768-4105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER J PENNANT
Title or Position: OWNER
Credential:
Phone: 407-296-7163