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General NPI Number Information
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NPI Number | 1417806381
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Entity Type | Organization
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Legal Business Name | FAIRWAY CHALET RESIDENCE ALF LLC
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Dates
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Enumeration Date | 01/24/2026
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Last Update Date | 01/24/2026
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Provider Practice Location Address
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Address Line | 905 VIRGINIA AVE
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-2677
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Country | US
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Telephone | 727-934-4970
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Fax | 727-943-9139
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Provider Business Mailing Address
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Address Line | 2838 AUDUBON VILLAGE DR UNIT 7124
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City | AUDUBON
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State | PA
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Zip | 19407-1006
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Country | US
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Telephone | 484-657-6444
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MARIA MORESCHI
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Credential |
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Telephone | 484-657-6444
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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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