Organization
NELA LLC
Active
Other names
DIXIE LODGE
Organization subpart
No
Provider details
NPI number
Authorized official
JACEK DYGDON (OWNER)
(386) 734-4830
Entity
Organization
Contact information
Practice address
647 S WOODLAND BLVD, DELAND, FL 32720-5810
(386) 734-4830
Mailing address
647 S WOODLAND BLVD, DELAND, FL 32720-5810
(386) 734-4830
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
AL1077
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002508600
—
FL
Enumeration date
01/28/2014
Last updated
01/28/2014
Update your record
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