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General NPI Number Information
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NPI Number | 1205421096
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Entity Type | Organization
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Legal Business Name | BRENDLYN ASSISTED LIVING LLC
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 9 FIELDSTONE LN
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City | PALM COAST
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State | FL
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Zip | 32137-9235
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Country | US
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Telephone | 386-225-4672
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Fax | 386-276-3068
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Provider Business Mailing Address
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Address Line | 9 FIELDSTONE LN
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City | PALM COAST
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State | FL
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Zip | 32137-9235
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Country | US
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Telephone | 386-225-4672
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Fax | 386-276-3068
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Authorized Official
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Title or Position | MANAGER
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Name | MR. ALBERT WATSON HARRINGTON III
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Credential |
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Telephone | 386-225-4672
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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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