Provider Demographics
NPI:1790153401
Name:MEMORIAL HEALTH SYSTEMS INC.
Entity Type:Organization
Organization Name:MEMORIAL HEALTH SYSTEMS INC.
Other - Org Name:FLORIDA HOSPITAL MEMORIAL & MEDICAL CENTER & FH OCEANSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-231-3909
Mailing Address - Street 1:301 MEMORIAL MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5167
Mailing Address - Country:US
Mailing Address - Phone:386-231-6000
Mailing Address - Fax:
Practice Address - Street 1:264 S ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-8149
Practice Address - Country:US
Practice Address - Phone:386-943-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4201314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility