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General NPI Number Information
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NPI Number | 1427594944
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Entity Type | Organization
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Legal Business Name | MANDEVILLE MANOR HEALTH SYSTEMS INC.
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Dates
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Enumeration Date | 01/07/2017
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Last Update Date | 01/07/2017
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Provider Practice Location Address
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Address Line | 40 PONCE DELEON DR
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City | PALM COAST
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State | FL
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Zip | 32164-4910
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Country | US
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Telephone | 386-586-5654
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Fax | 386-586-5440
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Provider Business Mailing Address
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Address Line | 40 PONCE DELEON DR
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City | PALM COAST
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State | FL
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Zip | 32164-4910
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Country | US
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Telephone | 386-586-5654
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Fax | 386-586-5440
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MARGARET MCLARTY
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Credential |
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Telephone | 386-679-4867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 00000000
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License Number State | FL
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