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General NPI Number Information
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NPI Number | 1154753911
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Entity Type | Organization
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Legal Business Name | NORTHWOOD MANOR LLC
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Dates
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Enumeration Date | 08/04/2013
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Last Update Date | 08/04/2013
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Provider Practice Location Address
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Address Line | 27737 BREAKERS DR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6685
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Country | US
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Telephone | 813-929-1656
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Fax | 813-428-5164
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Provider Business Mailing Address
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Address Line | 27737 BREAKERS DR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6685
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Country | US
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Telephone | 813-929-1656
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Fax | 813-428-5164
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Authorized Official
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Title or Position | OWNER/ AMINISTRATOR
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Name | MISS SHEREVE L ADAMS
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Credential | RT
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Telephone | 813-929-1656
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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 | AL11872
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License Number State | FL
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