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General NPI Number Information
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NPI Number | 1275969628
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Entity Type | Organization
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Legal Business Name | DELAND GERIATRIC CARE, INC.
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 208 BLUE CRYSTAL DRIVE
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City | DELAND
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State | FL
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Zip | 32720
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Country | US
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Telephone | 386-679-3375
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Fax | 386-738-9986
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Provider Business Mailing Address
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Address Line | 208 BLUE CRYSTAL DRIVE
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City | DELAND
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State | FL
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Zip | 32720
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Country | US
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Telephone | 386-679-3375
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Fax | 386-738-9986
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Authorized Official
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Title or Position | DIRECTOR, RESIDENT CARE SERVICES/CO
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Name | DR. RAMON LORENZANA GUTIERREZ
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Credential | DOM
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Telephone | 386-738-9986
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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 | AL8722
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License Number State | FL
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