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General NPI Number Information
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NPI Number | 1184113771
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Entity Type | Organization
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Legal Business Name | WINDERMERE ASSISTED LIVING FACILITY CORP
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 7050 BRAMLEA LN
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City | WINDERMERE
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State | FL
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Zip | 34786-6623
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Country | US
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Telephone | 407-656-0202
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Fax |
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Provider Business Mailing Address
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Address Line | 7050 BRAMLEA LN
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City | WINDERMERE
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State | FL
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Zip | 34786-6623
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Country | US
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Telephone | 407-656-0202
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. TESFAMARIAM G BAHTA
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Credential | PHARMD
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Telephone | 407-656-0202
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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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