Provider Demographics
NPI:1215394093
Name:MENORAH MANOR, INC
Entity Type:Organization
Organization Name:MENORAH MANOR, INC
Other - Org Name:IRV WEISSMAN ADULT DAY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-302-3702
Mailing Address - Street 1:255 59TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8539
Mailing Address - Country:US
Mailing Address - Phone:727-302-3702
Mailing Address - Fax:727-345-3957
Practice Address - Street 1:255 59TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8539
Practice Address - Country:US
Practice Address - Phone:727-302-3702
Practice Address - Fax:727-345-3957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8869261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014305500Medicaid