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General NPI Number Information
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NPI Number | 1376533174
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Entity Type | Organization
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Legal Business Name | CITY OF MARIANNA OFFICE OF CITY CLERK
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 4295 5TH AVE
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City | MARIANNA
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State | FL
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Zip | 32446-2176
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Country | US
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Telephone | 850-482-8091
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Fax | 850-482-6162
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Provider Business Mailing Address
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Address Line | 4295 5TH AVE
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City | MARIANNA
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State | FL
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Zip | 32446-2176
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Country | US
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Telephone | 850-482-8091
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Fax | 850-482-6162
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MELINDA S. GAY
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Credential | NHA
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Telephone | 850-482-8091
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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 | SNF1322096
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License Number State | FL
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