Provider Demographics
NPI:1932548435
Name:DENLY N, INC. DNA SAVANNAH MANOR
Entity Type:Organization
Organization Name:DENLY N, INC. DNA SAVANNAH MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANABAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-326-3637
Mailing Address - Street 1:1027 W. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748
Mailing Address - Country:US
Mailing Address - Phone:352-326-3637
Mailing Address - Fax:352-365-2300
Practice Address - Street 1:1027 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-326-3637
Practice Address - Fax:352-365-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5322310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0031898-00Medicaid