Provider Demographics
NPI:1033897889
Name:1031CF PALM COAST MT LLC
Entity Type:Organization
Organization Name:1031CF PALM COAST MT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-533-1031
Mailing Address - Street 1:2603 MAIN ST STE 1050
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4282
Mailing Address - Country:US
Mailing Address - Phone:844-533-1031
Mailing Address - Fax:
Practice Address - Street 1:3830 OLD KINGS RD
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-9262
Practice Address - Country:US
Practice Address - Phone:386-307-5445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility