=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346566346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANALEX OF FLAGLER BEACH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2010
-----------------------------------------------------
Last Update Date | 04/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2561 MOODY BLVD SUITE B
-----------------------------------------------------
City | FLAGLER BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-437-0200
-----------------------------------------------------
Fax | 386-310-1015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2561 MOODY BLVD SUITE B
-----------------------------------------------------
City | FLAGLER BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-437-0200
-----------------------------------------------------
Fax | 386-310-1015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT/ADMINISTRATOR
-----------------------------------------------------
Name | MRS. MARY K. WEATHERS
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 386-437-0200
-----------------------------------------------------
=====================================================
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 | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HHA299993719
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------