Provider Demographics
NPI:1336585843
Name:VAL MAR ENTERPRISES
Entity Type:Organization
Organization Name:VAL MAR ENTERPRISES
Other - Org Name:BUTTERFLY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VALDENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-688-1918
Mailing Address - Street 1:660 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4108
Mailing Address - Country:US
Mailing Address - Phone:727-896-4515
Mailing Address - Fax:727-824-6364
Practice Address - Street 1:660 3RD AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4108
Practice Address - Country:US
Practice Address - Phone:727-896-4515
Practice Address - Fax:727-824-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8739310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility