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General NPI Number Information
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NPI Number | 1972563526
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Entity Type | Organization
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Legal Business Name | RASTELLE MANOR
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 934 S RIDGEWOOD AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-5328
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Country | US
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Telephone | 386-252-2627
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Fax | 386-252-4236
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Provider Business Mailing Address
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Address Line | 934 S RIDGEWOOD AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-5328
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Country | US
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Telephone | 386-252-2627
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Fax | 386-252-4236
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. WINSTON CUBERO BERNABE
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Credential |
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Telephone | 386-252-2627
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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 | AL5777
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License Number State | FL
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