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General NPI Number Information
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NPI Number | 1114750692
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Entity Type | Organization
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Legal Business Name | JADE MANOR LLC
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Dates
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Enumeration Date | 08/21/2024
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 6625 OLD PASCO RD
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544
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Country | US
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Telephone | 786-340-8053
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Fax |
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Provider Business Mailing Address
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Address Line | 19467 BREYNIA DR
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City | LUTZ
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State | FL
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Zip | 33558-5538
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Country | US
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Telephone | 786-340-8053
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IRVIN MORALES
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Credential |
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Telephone | 786-340-8053
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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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