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General NPI Number Information
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NPI Number | 1376725358
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Entity Type | Organization
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Legal Business Name | FAL-BLOOMINGTON, INC
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 05/22/2009
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Provider Practice Location Address
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Address Line | 120 E MILLER DR
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City | BLOOMINGTON
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State | IN
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Zip | 47401-6538
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Country | US
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Telephone | 812-336-1055
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Fax | 812-336-0934
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Provider Business Mailing Address
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Address Line | 120 E MILLER DR
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City | BLOOMINGTON
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State | IN
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Zip | 47401-6538
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Country | US
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Telephone | 812-336-1055
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Fax | 812-336-0934
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Authorized Official
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Title or Position | CFO
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Name | MR. WILLIAM P MANDO
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Credential |
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Telephone | 813-635-9500
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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 |
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License Number State |
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