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General NPI Number Information
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NPI Number | 1982045753
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Entity Type | Organization
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Legal Business Name | SWAN AT LAKE CONWAY
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 3714 SAINT MORITZ ST
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City | BELLE ISLE
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State | FL
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Zip | 32812-1135
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Country | US
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Telephone | 407-860-0266
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Fax |
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Provider Business Mailing Address
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Address Line | 3714 SAINT MORITZ ST
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City | BELLE ISLE
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State | FL
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Zip | 32812-1135
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASTER WORKU BATI
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Credential |
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Telephone | 407-860-0266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 11542
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License Number State | FL
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