Provider Demographics
NPI:1811451404
Name:COBBLESTON MANOR ,ALF
Entity type:Organization
Organization Name:COBBLESTON MANOR ,ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MORZYSZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-688-9549
Mailing Address - Street 1:208 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-6331
Mailing Address - Country:US
Mailing Address - Phone:727-688-9549
Mailing Address - Fax:352-556-3267
Practice Address - Street 1:208 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-6331
Practice Address - Country:US
Practice Address - Phone:727-688-9549
Practice Address - Fax:352-606-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101363800Medicaid
GA101363800Medicaid