Provider Demographics
NPI:1659607463
Name:MF HALIFAX, LLC
Entity Type:Organization
Organization Name:MF HALIFAX, LLC
Other - Org Name:COASTAL HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-390-4377
Mailing Address - Street 1:820 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4594
Mailing Address - Country:US
Mailing Address - Phone:386-274-4575
Mailing Address - Fax:
Practice Address - Street 1:820 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4594
Practice Address - Country:US
Practice Address - Phone:386-274-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA FACILITIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility