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General NPI Number Information
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NPI Number | 1205242864
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Entity Type | Organization
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Legal Business Name | ELIZABETH ANN MARIE TAYLOR
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Dates
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Enumeration Date | 07/03/2014
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 1474 MEADOWBROOK RD NE
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City | PALM BAY
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State | FL
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Zip | 32905-5007
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Country | US
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Telephone | 912-373-2779
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Fax |
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Provider Business Mailing Address
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Address Line | 1474 MEADOWBROOK RD NE
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City | PALM BAY
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State | FL
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Zip | 32905-5007
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Country | US
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Telephone | 912-373-2779
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ELIZABETH ANN MARIE TAYLOR
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Credential |
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Telephone | 321-373-2187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6906692
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License Number State | FL
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