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NPI Code Detail

MEDICARE: EMERALD MANOR LLC

MEDICARE: EMERALD MANOR LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living FacilityFL

General Provider Information

NPI Number : 1114433232
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMERALD MANOR LLC
Provider Business Mailing Address
First Line : 22 REGAL DR
Second Line :
City : NEW ROCHELLE
State : NY
Zip : 10804-1202
Country : US
Telephone Number : 914-548-7617
Fax Number : 914-633-1620
Provider Business Practice Location Address
First Line : 12221 W DIXIE HWY
Second Line :
City : NORTH MIAMI
State : FL
Zip : 33161-5427
Country : US
Telephone Number : 914-548-7617
Fax Number : 914-633-1620
Authorized Official
Title or Position : MANAGER
Name : STEVEN BICKY
Credential :
Telephone Number : 914-548-7617
Provider Enumeration Date : 12/27/2017
Last Update Date : 12/27/2017

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Directions to “EMERALD MANOR LLC ” Practice Location

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