Provider Demographics
NPI:1194197707
Name:IRIS MANOR LLC
Entity Type:Organization
Organization Name:IRIS MANOR LLC
Other - Org Name:IRIS MANOR ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ARSENAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-543-7474
Mailing Address - Street 1:1295 DELTONA BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-6346
Mailing Address - Country:US
Mailing Address - Phone:917-543-7474
Mailing Address - Fax:855-984-1662
Practice Address - Street 1:1295 DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-6346
Practice Address - Country:US
Practice Address - Phone:917-543-7474
Practice Address - Fax:855-984-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12652310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility