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General NPI Number Information
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NPI Number | 1003315961
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Entity Type | Organization
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Legal Business Name | FAIRVIEW MANOR, INC.
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1310 FAIRVIEW AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-3647
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Country | US
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Telephone | 407-331-0980
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Fax | 407-622-1443
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Provider Business Mailing Address
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Address Line | 1310 FAIRVIEW AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-3647
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Country | US
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Telephone | 407-331-0980
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Fax | 407-622-1443
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MANUEL VICENTE MEDINA
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Credential |
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Telephone | 407-331-0980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12826
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License Number State | FL
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