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General NPI Number Information
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NPI Number | 1619354768
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Entity Type | Organization
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Legal Business Name | PARKVIEW ASSISTED LIVING FACILITY, LLC
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 04/28/2015
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Provider Practice Location Address
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Address Line | 735 W WISCONSIN AVE
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City | DELAND
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State | FL
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Zip | 32720-4076
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Country | US
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Telephone | 386-738-4078
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Fax | 386-734-7001
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Provider Business Mailing Address
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Address Line | 735 W WISCONSIN AVE
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City | DELAND
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State | FL
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Zip | 32720-4076
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Country | US
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Telephone | 386-738-4078
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Fax | 386-734-7001
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SARAH DEPOSOY PRADO
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Credential | RN
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Telephone | 386-747-2109
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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 | AL10665
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License Number State | FL
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