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General NPI Number Information
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NPI Number | 1851553317
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Entity Type | Organization
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Legal Business Name | PENDRY ESTATE
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 36120 HUFF RD
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City | EUSTIS
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State | FL
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Zip | 32736-9335
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Country | US
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Telephone | 352-357-2268
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Fax | 352-357-2065
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Provider Business Mailing Address
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Address Line | 36120 HUFF RD
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City | EUSTIS
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State | FL
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Zip | 32736-9335
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Country | US
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Telephone | 352-357-2268
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Fax | 352-357-2065
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Authorized Official
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Title or Position | PROVIDER
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Name | MR. DAVID FORSTER
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Credential |
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Telephone | 352-357-2268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6906206
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License Number State | FL
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