=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205078136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D&F ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2009
-----------------------------------------------------
Last Update Date | 03/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3918 S KINGS AVE
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-7749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-662-1535
-----------------------------------------------------
Fax | 813-681-3585
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3918 S KINGS AVE
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-7749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-662-1535
-----------------------------------------------------
Fax | 813-681-3585
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | GEORGE EDWARD FUSIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-662-1535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL9059
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------