Organization
HERITAGE WATERSIDE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK NAGRANI MD (OWNER)
(386) 256-2015
Entity
Organization
Contact information
Practice address
3704 CARDINAL BLVD, DAYTONA BEACH SHORES, FL 32118-7301
(386) 256-2015
Mailing address
3704 CARDINAL BLVD, DAYTONA BEACH SHORES, FL 32118-7301
(386) 256-2015
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109599800
—
FL
Enumeration date
05/11/2021
Last updated
05/11/2021
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