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General NPI Number Information
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NPI Number | 1871745265
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Entity Type | Organization
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Legal Business Name | TOTAL CARE MANOR, INC
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 08/26/2020
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Provider Practice Location Address
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Address Line | 1490 NW 21 STREET
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311
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Country | US
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Telephone | 954-523-1543
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Fax | 954-527-0505
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Provider Business Mailing Address
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Address Line | 1490 NW 21 STREET
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311
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Country | US
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Telephone | 954-523-1543
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Fax | 954-527-0505
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON KISSOONLAL
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Credential |
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Telephone | 954-523-1543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AL8595
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License Number State | FL
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