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General NPI Number Information
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NPI Number | 1174515654
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Entity Type | Organization
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Legal Business Name | FLORIDA DEPARTMENT OF VETERANS AFFAIRS
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 1920 MASON AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5103
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Country | US
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Telephone | 386-274-3460
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Fax | 386-274-3487
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Provider Business Mailing Address
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Address Line | 1920 MASON AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5103
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Country | US
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Telephone | 386-274-3460
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Fax | 386-274-3487
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MISS CLAUDIA RENEE DAY
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Credential |
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Telephone | 727-518-3202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF1143095
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License Number State | FL
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