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General NPI Number Information
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NPI Number | 1013648468
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Entity Type | Organization
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Legal Business Name | CROWN ASSISTED LIVING LLC
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 06/17/2022
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Provider Practice Location Address
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Address Line | 301 MILFORD PL
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-6826
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Country | US
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Telephone | 386-409-7993
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Fax | 386-409-7993
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Provider Business Mailing Address
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Address Line | 301 MILFORD PL
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-6826
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Country | US
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Telephone | 386-409-7993
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Fax | 386-409-7993
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JURIS BERGS
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Credential |
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Telephone | 386-333-2434
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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 |
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License Number State |
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