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Organization
STEPHENS MEMORIAL HOME
Active
Organization
STEPHENS MEMORIAL HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA STEPHENS (OWNER/PROVIDER)
(904) 797-0294
Entity
Organization
Contact information
Practice address
5805 DATIL PEPPER RD, SAINT AUGUSTINE, FL 32086-5699
(904) 797-0294
(904) 797-6372
Mailing address
5805 DATIL PEPPER RD, SAINT AUGUSTINE, FL 32086-5699
(904) 797-0294
(904) 797-6372
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL10189
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
685603900
—
FL
Enumeration date
04/26/2013
Last updated
04/26/2013
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