Provider Demographics
NPI:1407292238
Name:TROYANDJENNYENTERPRISES,INC
Entity Type:Organization
Organization Name:TROYANDJENNYENTERPRISES,INC
Other - Org Name:SOUTHERNLIVINGFORSENIORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:HENDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-973-6892
Mailing Address - Street 1:765 NE DELPHINIUM DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-5412
Mailing Address - Country:US
Mailing Address - Phone:850-973-6892
Mailing Address - Fax:850-973-1268
Practice Address - Street 1:765 NE DELPHINIUM DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-5412
Practice Address - Country:US
Practice Address - Phone:850-973-6892
Practice Address - Fax:850-973-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL6020310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688739200Medicaid