MEDICARE: SHELTON MANOR INC

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

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	:	1821617333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELTON MANOR INC

Provider Business Mailing Address
First Line	:	9700 PENSACOLA BLVD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-1242
Country	:	US
Telephone Number	:	850-741-3540
Fax Number	:	850-857-8079

Provider Business Practice Location Address
First Line	:	9700 PENSACOLA BLVD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-1242
Country	:	US
Telephone Number	:	850-741-3540
Fax Number	:	850-857-8079

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARANDA DEAN SHELTON
Credential	:
Telephone Number	:	850-982-3745

Provider Enumeration Date	:	04/14/2020
Last Update Date	:	04/14/2020

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Directions to “SHELTON MANOR INC ” Practice Location

Language	Start Address	Practice Location

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