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General NPI Number Information
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NPI Number | 1407437106
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Entity Type | Organization
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Legal Business Name | AGNES COTTAGE LLC
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 3739 SUNRISE OAKS DR
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City | PORT ORANGE
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State | FL
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Zip | 32129-8651
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Country | US
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Telephone | 386-265-4732
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Fax | 407-902-0121
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Provider Business Mailing Address
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Address Line | 10957 LEDGEMENT LN
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City | WINDERMERE
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State | FL
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Zip | 34786-6423
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Country | US
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Telephone | 240-550-2211
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Fax | 407-902-0121
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | ABIOLA BYRON
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Credential |
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Telephone | 240-550-2211
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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 |
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License Number State |
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