Organization
DEPAUL OF WEST ORLANDO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRTLE JOYCE BENJAMIN-RICHARDS (OWNER / NURSE ADMINISTRATOR)
(407) 292-0515
Entity
Organization
Contact information
Practice address
1201 PAUL ST, ORLANDO, FL 32808-6938
(407) 292-0515
(407) 292-4818
Mailing address
1201 PAUL ST, ORLANDO, FL 32808-6938
(407) 292-0515
(407) 292-4818
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL9119
FL
310400000X
Assisted Living Facility
RN 916612
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140219600
—
FL
01
—
678900500
MEDICARE
FL
Enumeration date
11/04/2010
Last updated
11/04/2010
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