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General NPI Number Information
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NPI Number | 1316336266
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Entity Type | Organization
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Legal Business Name | MJ CHILDRENS PAVILLION, INS
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 728 S ENDEAVOUR DR
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-5167
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Country | US
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Telephone | 407-699-4255
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Fax |
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Provider Business Mailing Address
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Address Line | 728 S ENDEAVOUR DR
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-5167
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JOAN TYRELL
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Credential |
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Telephone | 407-699-4255
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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 | AL12589
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License Number State | FL
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