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General NPI Number Information
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NPI Number | 1437491677
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Entity Type | Organization
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Legal Business Name | MONASTERY OAKS, LLC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 1801 MONASTERY RD
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City | ORANGE CITY
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State | FL
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Zip | 32763-6320
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Country | US
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Telephone | 386-456-0049
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Fax | 386-456-0061
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Provider Business Mailing Address
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Address Line | 248 VIA TUSCANY LOOP
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City | LAKE MARY
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State | FL
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Zip | 32746-1543
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER MEMBER
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Name | MR. JERRY M CUTRONA
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Credential |
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Telephone | 386-456-0049
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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 | AL12195
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License Number State | FL
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