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General NPI Number Information
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NPI Number | 1497811533
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Entity Type | Organization
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Legal Business Name | PONDELLA SERENITY COURT, LLC
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Dates
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Enumeration Date | 12/30/2006
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Last Update Date | 11/11/2010
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Provider Practice Location Address
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Address Line | 1923 NE 6TH ST
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City | CAPE CORAL
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State | FL
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Zip | 33909-2271
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Country | US
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Telephone | 239-242-0597
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Fax | 239-458-5595
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Provider Business Mailing Address
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Address Line | 1923 NE 6TH ST
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City | CAPE CORAL
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State | FL
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Zip | 33909-2271
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Country | US
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Telephone | 239-242-0597
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Fax | 239-458-5595
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Authorized Official
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Title or Position | ACCOUNTANT
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Name | MARCIAL / OR YOLETTE OSSELIN
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Credential |
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Telephone | 239-242-0597
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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 | AL10725
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License Number State | FL
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