Provider Demographics
NPI:1013267848
Name:DEERFOOT MANOR ALF
Entity Type:Organization
Organization Name:DEERFOOT MANOR ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:ABARRO
Authorized Official - Last Name:PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-880-4393
Mailing Address - Street 1:374 DEERFOOT RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-7950
Mailing Address - Country:US
Mailing Address - Phone:386-734-3519
Mailing Address - Fax:386-734-7463
Practice Address - Street 1:374 DEERFOOT RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-7950
Practice Address - Country:US
Practice Address - Phone:386-734-3519
Practice Address - Fax:386-734-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL4744261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility