Provider Demographics
NPI:1073927836
Name:TERESA N GASCON
Entity Type:Organization
Organization Name:TERESA N GASCON
Other - Org Name:DELAND ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:N
Authorized Official - Last Name:GASCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-736-0022
Mailing Address - Street 1:768 S DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-6618
Mailing Address - Country:US
Mailing Address - Phone:386-736-0022
Mailing Address - Fax:386-736-0022
Practice Address - Street 1:768 S DEXTER AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-6618
Practice Address - Country:US
Practice Address - Phone:386-736-0022
Practice Address - Fax:386-736-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6076310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility