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General NPI Number Information
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NPI Number | 1285991265
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Entity Type | Organization
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Legal Business Name | PENNEY RETIREMENT COMMUNITY, INC.
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Dates
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Enumeration Date | 04/16/2012
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Last Update Date | 04/16/2012
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Provider Practice Location Address
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Address Line | 1 PAVILION PLACE
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City | PENNEY FARMS
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State | FL
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Zip | 32079-0555
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Country | US
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Telephone | 904-284-8582
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Fax | 904-284-6259
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Provider Business Mailing Address
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Address Line | PO BOX 555
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City | PENNEY FARMS
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State | FL
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Zip | 32079-0555
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Country | US
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Telephone | 904-284-8582
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Fax | 904-284-6259
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. BARBARA MARIE ENGELKES
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Credential | LNHA
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Telephone | 904-284-8582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF1325096
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License Number State | FL
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