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General NPI Number Information
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NPI Number | 1679915995
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Entity Type | Organization
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Legal Business Name | NORMANDY MANOR
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Dates
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Enumeration Date | 07/28/2013
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Last Update Date | 07/28/2013
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Provider Practice Location Address
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Address Line | 1654 MIDNIGHT PASS WAY
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City | CLEARWATER
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State | FL
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Zip | 33765-1820
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Country | US
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Telephone | 727-797-9461
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Fax | 727-723-1524
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Provider Business Mailing Address
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Address Line | 1103 NORMANDY RD
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City | CLEARWATER
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State | FL
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Zip | 33764-4825
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Country | US
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Telephone | 727-797-9461
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Fax | 727-723-1524
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. NOVELYN LAO BELDIA
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Credential | LPN
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Telephone | 727-797-9461
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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 | AL5194
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License Number State | FL
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