=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285212787
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NL MURRAY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2021
-----------------------------------------------------
Last Update Date | 03/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4025 BEXHILL DR
-----------------------------------------------------
City | NEW SMYRNA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32168-9019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-214-8085
-----------------------------------------------------
Fax | 386-410-4738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4025 BEXHILL DR
-----------------------------------------------------
City | NEW SMYRNA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32168-9019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-214-8085
-----------------------------------------------------
Fax | 386-410-4738
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NIKOLE L MURRAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 386-214-8085
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------