Organization
SELAH - FOREST LAKE MANOR, LLC
Active
Parent organization
SELAH SENIORCARE II
Other names
Forest Lake Manor
Organization subpart
Yes
Provider details
NPI number
Legal business name
SELAH SENIORCARE II
Authorized official
MR. ALAN DANIEL PARRISH (MANAGER)
(904) 543-1818
Entity
Organization
Contact information
Practice address
252 FOREST LAKE BLVD, DAYTONA BEACH, FL 32119-8106
(386) 760-7174
(386) 760-7812
Mailing address
252 FOREST LAKE BLVD, DAYTONA BEACH, FL 32119-8106
(386) 760-7174
(386) 760-7812
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL8869
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003453400
—
FL
Enumeration date
11/15/2012
Last updated
11/15/2012
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