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General NPI Number Information
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NPI Number | 1710370481
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Entity Type | Organization
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Legal Business Name | ENCHANTED LIVING FACILITY
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 6224 BOLLING DR
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City | ORLANDO
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State | FL
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Zip | 32808-6010
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Country | US
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Telephone | 407-230-3569
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Fax |
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Provider Business Mailing Address
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Address Line | 6224 BOLLING DR
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City | ORLANDO
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State | FL
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Zip | 32808-6010
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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 | OWNER
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Name | MRS. ELLA L DICKENS
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Credential |
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Telephone | 407-230-3569
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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 | AL12612
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License Number State | FL
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