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General NPI Number Information
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NPI Number | 1609420322
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Entity Type | Organization
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Legal Business Name | VISION MANOT, INC
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Dates
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Enumeration Date | 07/31/2019
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 319 ELDRIDGE AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-2956
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Country | US
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Telephone | 904-662-2331
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Fax |
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Provider Business Mailing Address
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Address Line | 2040 SOUTEL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32208-2280
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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 | EXECUTIVE DIRECTOR
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Name | MS. BERTHA D FLEMMING
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Credential |
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Telephone | 904-662-2331
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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 |
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License Number State |
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