Provider Demographics
NPI:1760649412
Name:CMFMC INC
Entity Type:Organization
Organization Name:CMFMC INC
Other - Org Name:AZALEA MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PROSERFINO
Authorized Official - Middle Name:
Authorized Official - Last Name:PATACSIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-282-0556
Mailing Address - Street 1:150 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3222
Mailing Address - Country:US
Mailing Address - Phone:407-282-0556
Mailing Address - Fax:407-282-2231
Practice Address - Street 1:150 WILLOW DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3222
Practice Address - Country:US
Practice Address - Phone:407-282-0556
Practice Address - Fax:407-282-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL48393104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691349100Medicaid