Healthcare Provider Details

I. General information

NPI: 1790153401
Provider Name (Legal Business Name): MEMORIAL HEALTH SYSTEMS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 S ATLANTIC AVE
ORMOND BEACH FL
32176-8149
US

IV. Provider business mailing address

301 MEMORIAL MEDICAL PKWY
DAYTONA BEACH FL
32117-5167
US

V. Phone/Fax

Practice location:
  • Phone: 386-943-4522
  • Fax:
Mailing address:
  • Phone: 386-231-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4201
License Number StateFL

VIII. Authorized Official

Name: CORY DOMAYER
Title or Position: CFO
Credential:
Phone: 386-231-3909