Healthcare Provider Details

I. General information

NPI: 1841406428
Provider Name (Legal Business Name): ASHTON PALMS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 W ESTHER ST
ORLANDO FL
32806-3927
US

IV. Provider business mailing address

36 W ESTHER ST
ORLANDO FL
32806-3927
US

V. Phone/Fax

Practice location:
  • Phone: 407-425-8071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL10096
License Number StateFL

VIII. Authorized Official

Name: TERESA GAIL PHELPS
Title or Position: PRESIDENT ADMINISTRATOR
Credential:
Phone: 407-425-8071