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General NPI Number Information
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NPI Number | 1760783872
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Entity Type | Organization
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Legal Business Name | DEPAUL OF WEST ORLANDO
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 11/04/2010
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Provider Practice Location Address
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Address Line | 1201 PAUL ST
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City | ORLANDO
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State | FL
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Zip | 32808-6938
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Country | US
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Telephone | 407-292-0515
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Fax | 407-292-4818
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Provider Business Mailing Address
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Address Line | 1201 PAUL ST
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City | ORLANDO
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State | FL
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Zip | 32808-6938
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Country | US
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Telephone | 407-292-0515
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Fax | 407-292-4818
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Authorized Official
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Title or Position | OWNER / NURSE ADMINISTRATOR
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Name | MYRTLE JOYCE BENJAMIN-RICHARDS
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Credential |
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Telephone | 407-292-0515
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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 | RN 916612
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL9119
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License Number State | FL
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