Organization
SHADY OAKS REST HOME INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES HAM (MANAGER)
(386) 562-0870
Entity
Organization
Contact information
Practice address
1208 KENNEDY RD, DAYTONA BEACH, FL 32117
(386) 253-6993
Mailing address
1208 KENNEDY RD, DAYTONA BEACH, FL 32117
(386) 253-6993
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
10293
FL
310400000X
Assisted Living Facility
AL10293
FL
Other
Enumeration date
05/31/2012
Last updated
10/27/2014
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