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General NPI Number Information
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NPI Number | 1598978223
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Entity Type | Organization
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Legal Business Name | ROSE MANOR INC
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 NORTH STREET
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City | DELAND
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State | FL
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Zip | 32720
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Country | US
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Telephone | 386-738-5982
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Fax | 386-943-4020
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Provider Business Mailing Address
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Address Line | 120 NORTH STREET
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City | DELAND
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State | FL
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Zip | 32720
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Country | US
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Telephone | 386-738-5982
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Fax | 386-943-4020
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Authorized Official
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Title or Position | OWNER ADMINISTRATOR
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Name | DEBORAH A TOLAN
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Credential | RN
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Telephone | 386-717-8592
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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 | 7585
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License Number State | FL
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