MEDICARE: HOWELLS ASSISTED LIVING FACILITY # 2

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	AL9953	FL

General Provider Information

NPI Number	:	1588911358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOWELLS ASSISTED LIVING FACILITY # 2

Provider Business Mailing Address
First Line	:	541 MOUNTAIN VALLEY RD
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-8635
Country	:	US
Telephone Number	:	850-892-0631
Fax Number	:

Provider Business Practice Location Address
First Line	:	541 MOUNTAIN VALLEY RD
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-8635
Country	:	US
Telephone Number	:	850-892-0631
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. FRANCES MARGARETTA HOWELL
Credential	:	RN
Telephone Number	:	850-892-0631

Provider Enumeration Date	:	08/10/2012
Last Update Date	:	08/10/2012

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