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General NPI Number Information
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NPI Number | 1952602948
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Entity Type | Organization
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Legal Business Name | ALF AT MERRITT ISLAND LLC
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 05/01/2014
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Provider Practice Location Address
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Address Line | 535 CROCKETT BLVD
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-5018
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Country | US
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Telephone | 850-392-0600
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Fax | 850-392-0000
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Provider Business Mailing Address
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Address Line | 535 CROCKETT BLVD
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-5018
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Country | US
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Telephone | 850-392-0600
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Fax | 850-392-0000
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Authorized Official
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Title or Position | MANAGER
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Name | JOHN E WARREN
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Credential |
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Telephone | 850-392-0600
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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 | AL8975
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License Number State | FL
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