Provider Demographics
NPI:1417556978
Name:MH GENTRY PARK AL OPERATING, LLC
Entity Type:Organization
Organization Name:MH GENTRY PARK AL OPERATING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-595-6025
Mailing Address - Street 1:3201 CENTER POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6323
Mailing Address - Country:US
Mailing Address - Phone:321-236-4406
Mailing Address - Fax:407-845-0886
Practice Address - Street 1:3201 CENTER POINTE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-6323
Practice Address - Country:US
Practice Address - Phone:321-236-4406
Practice Address - Fax:407-845-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)