=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770289100
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERINO ADULT FAMILY CARE HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2023
-----------------------------------------------------
Last Update Date | 02/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1510 DINGENS AVE
-----------------------------------------------------
City | WINDERMERE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34786-8000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-295-8872
-----------------------------------------------------
Fax | 407-601-3554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1510 DINGENS AVE
-----------------------------------------------------
City | WINDERMERE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34786-8000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-295-8872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MGR
-----------------------------------------------------
Name | DAYSI M. MERINO
-----------------------------------------------------
Credential | ADMINISTRATOR
-----------------------------------------------------
Telephone | 347-693-3620
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------