Provider Demographics
NPI:1629515333
Name:ANEWERFACE, INC
Entity Type:Organization
Organization Name:ANEWERFACE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:FALASCO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:386-801-1253
Mailing Address - Street 1:261 WEST GARDENIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763
Mailing Address - Country:US
Mailing Address - Phone:386-801-1253
Mailing Address - Fax:
Practice Address - Street 1:ADDRESS: 123 N INDUSTRIAL DR STE C
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763
Practice Address - Country:US
Practice Address - Phone:386-801-1253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2909852261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ22435Medicare UPIN