MEDICARE: MULLINS CANTERBURY 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
1	310400000X	Assisted Living Facility	12418	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750718482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULLINS CANTERBURY LLC

Provider Business Mailing Address
First Line	:	3260 GRETNA DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-2831
Country	:	US
Telephone Number	:	352-200-1689
Fax Number	:

Provider Business Practice Location Address
First Line	:	7355 CANTERBURY ST
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-4302
Country	:	US
Telephone Number	:	352-600-9263
Fax Number	:	352-683-8630

Authorized Official
Title or Position	:	OWNER
Name	:	DEBORAH MULLINS
Credential	:
Telephone Number	:	352-200-1689

Provider Enumeration Date	:	09/26/2013
Last Update Date	:	09/26/2013

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