Provider Demographics
NPI:1659762003
Name:ORMOND ALF MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ORMOND ALF MANAGEMENT, LLC
Other - Org Name:GOLDEN ABBEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEETER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:407-202-0046
Mailing Address - Street 1:283 AGNES AVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6105
Mailing Address - Country:US
Mailing Address - Phone:407-202-0046
Mailing Address - Fax:
Practice Address - Street 1:1410 HAND AVE
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8193
Practice Address - Country:US
Practice Address - Phone:407-202-0046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility