Dixie Oak Manor LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL8502 Issued in FL

Legal business name

DIXIE OAK MANOR LLC

Practice address

6410 Old Dixie Hwy
Vero Beach, FL 32967-5909

Phone

(772) 564-6363

NPI assigned

Aug 19, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Scott Funnell

Title

Owner/Administrator

Phone

(772) 564-9393

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376870400000",
    "number": "1124451687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6410 OLD DIXIE HWY",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329675909",
            "telephone_number": "772-564-6363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 OLD DIXIE HWY",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329675909",
            "telephone_number": "772-564-6363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIXIE OAK MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-19",
        "last_updated": "2013-08-19",
        "status": "A",
        "authorized_official_last_name": "FUNNELL",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "772-564-9393",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL8502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Vero Beach, FL
• Providers in Vero Beach, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.