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General NPI Number Information
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NPI Number | 1811704570
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Entity Type | Organization
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Legal Business Name | INGLENOOK HOUSE AFH, CO.
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 280 PINE ST
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City | ENGLEWOOD
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State | FL
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Zip | 34223-3948
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Country | US
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Telephone | 941-474-5563
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Fax |
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Provider Business Mailing Address
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Address Line | 280 PINE ST
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City | ENGLEWOOD
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State | FL
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Zip | 34223-3948
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Country | US
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Telephone | 941-474-5563
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EUGENE RICK VIAN
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Credential | RN
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Telephone | 253-344-9601
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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 |
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License Number State |
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