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General NPI Number Information
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NPI Number | 1962741660
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Entity Type | Organization
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Legal Business Name | FAITH HOUSE OF WINTER PARK
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 290 STONER RD
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-3122
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Country | US
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Telephone | 407-327-3952
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Fax |
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Provider Business Mailing Address
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Address Line | 1604 BOMI CIR
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City | WINTER PARK
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State | FL
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Zip | 32792-6315
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Country | US
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Telephone | 407-679-2871
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARY DURAND
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Credential | RN
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Telephone | 407-327-3952
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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 | AL11899
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License Number State | FL
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