MEDICARE: FARRINGTON HOUSE 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	AL11613	FL

General Provider Information

NPI Number	:	1841557931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARRINGTON HOUSE LLC

Provider Business Mailing Address
First Line	:	1970 FARRINGTON DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-5532
Country	:	US
Telephone Number	:	321-208-7955
Fax Number	:	321-208-7956

Provider Business Practice Location Address
First Line	:	1970 FARRINGTON DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-5532
Country	:	US
Telephone Number	:	321-208-7955
Fax Number	:	321-208-7956

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. CHERYL DENISE KNABLE
Credential	:	LPN
Telephone Number	:	321-208-7955

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	04/13/2012

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