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General NPI Number Information
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NPI Number | 1538192208
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Entity Type | Organization
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Legal Business Name | PHOENIX HEALTHCARE PROPERTIES OF MANDARIN, LLC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 12/01/2009
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Provider Practice Location Address
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Address Line | 10680 SAINT AUGUSTINE ROAD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-1000
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Country | US
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Telephone | 904-268-4953
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Fax |
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Provider Business Mailing Address
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Address Line | 199 NE 89TH STREET
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City | EL PORTAL
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State | FL
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Zip | 33138-3010
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Country | US
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Telephone | 305-759-4046
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Fax | 305-759-4056
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. DION R. SENA
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Credential |
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Telephone | 305-759-4046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF13060961
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License Number State | FL
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