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NPI Code Detail

MEDICARE: MF HERITAGE LLC

MEDICARE: MF HERITAGE 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1659530491
Entity Type Code : Organization
Provider Name (Legal Business Name) : MF HERITAGE LLC
Provider Business Mailing Address
First Line : 40 SOUTH PALAFOX PLACE
Second Line : SUITE 400
City : PENSACOLA
State : FL
Zip : 32502-5697
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 37135 COLEMAN AVE
Second Line :
City : DADE CITY
State : FL
Zip : 33525-4526
Country : US
Telephone Number : 352-567-8615
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JAMES RICHARDSON
Credential :
Telephone Number : 850-430-0000
Provider Enumeration Date : 06/06/2008
Last Update Date : 10/05/2015

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