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General NPI Number Information
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NPI Number | 1780849745
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Entity Type | Organization
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Legal Business Name | MEDALLION HEALTH CARE SERVICES
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 308 S. MARTIN LUTHER KING BLVD. STE. 113
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City | DAYTONA BEACH
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State | FL
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Zip | 32114
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Country | US
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Telephone | 386-405-4155
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Fax |
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Provider Business Mailing Address
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Address Line | 815 KOTTLE CIR S
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4719
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Country | US
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Telephone | 386-405-4155
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KEONA LATOSHA SLATER
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Credential |
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Telephone | 386-405-4155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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