MEDICARE: KEVRONA MANOR ALF

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
1	310400000X	Assisted Living Facility		FL

General Provider Information

NPI Number	:	1568712008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVRONA MANOR ALF

Provider Business Mailing Address
First Line	:	5536 KINGSWOOD DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-4552
Country	:	US
Telephone Number	:	321-972-6225
Fax Number	:

Provider Business Practice Location Address
First Line	:	5536 KINGSWOOD DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-4552
Country	:	US
Telephone Number	:	321-972-6225
Fax Number	:

Authorized Official
Title or Position	:	OWNER / ADMINISTRATOR
Name	:	VERONA EDWARDS
Credential	:
Telephone Number	:	321-972-6225

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	09/12/2012

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Directions to “KEVRONA MANOR ALF ” Practice Location

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