Provider Demographics
NPI:1790134310
Name:WINDERMERE MEMORY CARE INC.
Entity Type:Organization
Organization Name:WINDERMERE MEMORY CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-477-1600
Mailing Address - Street 1:7901 KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6265
Mailing Address - Country:US
Mailing Address - Phone:850-477-1600
Mailing Address - Fax:850-477-0004
Practice Address - Street 1:7901 KIPLING ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6265
Practice Address - Country:US
Practice Address - Phone:850-477-1600
Practice Address - Fax:850-477-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-04
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12844310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility