Organization
MANDEVILLE MANOR HEALTH SYSTEMS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARGARET MCLARTY (CHIEF FINANCIAL OFFICER)
(386) 679-4867
Entity
Organization
Contact information
Practice address
40 PONCE DELEON DR, PALM COAST, FL 32164-4910
(386) 586-5654
(386) 586-5440
Mailing address
40 PONCE DELEON DR, PALM COAST, FL 32164-4910
(386) 586-5654
(386) 586-5440
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
00000000
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
676845896
—
FL
Enumeration date
01/07/2017
Last updated
01/07/2017
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