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General NPI Number Information
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NPI Number | 1982097572
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Entity Type | Organization
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Legal Business Name | ALANSON ACRES ACTIVE SENIOR LIVING LLC.
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 1644 ALANSON DR
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City | DELAND
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State | FL
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Zip | 32724-7907
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Country | US
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Telephone | 386-873-7407
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Fax |
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Provider Business Mailing Address
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Address Line | 1644 ALANSON DR
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City | DELAND
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State | FL
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Zip | 32724-7907
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Country | US
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Telephone | 386-873-7407
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ELLEN V. CLARK-MOREFIELD
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Credential |
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Telephone | 386-873-7407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6906736
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License Number State | FL
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