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General NPI Number Information
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NPI Number | 1700815859
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Entity Type | Organization
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Legal Business Name | R&JOAKMONT
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5520 HOWELL BRANCH RD
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City | WINTER PARK
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State | FL
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Zip | 32792-9327
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Country | US
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Telephone | 407-679-1116
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Fax | 407-657-7586
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Provider Business Mailing Address
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Address Line | 5520 HOWELL BRANCH RD
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City | WINTER PARK
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State | FL
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Zip | 32792-9327
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Country | US
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Telephone | 407-679-1116
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Fax | 407-657-7586
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Authorized Official
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Title or Position | OWNER/ADM.
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Name | MRS. FREDA A JOHNSON
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Credential |
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Telephone | 407-679-1116
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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 | AL8419
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License Number State | FL
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