Provider Demographics
NPI:1639310899
Name:WHITE, VALFORD
Entity Type:Individual
Prefix:
First Name:VALFORD
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EMMANUEL MANOR
Other - Middle Name:
Other - Last Name:ASSISTED LIVING FACILITY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4930 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2625
Mailing Address - Country:US
Mailing Address - Phone:727-289-3416
Mailing Address - Fax:727-289-3418
Practice Address - Street 1:4930 10TH AVE S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-2625
Practice Address - Country:US
Practice Address - Phone:727-289-3416
Practice Address - Fax:727-289-3418
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11173374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide