Mandeville Manor Health Systems Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

00000000 Issued in FL

Legal business name

MANDEVILLE MANOR HEALTH SYSTEMS INC.

Practice address

40 Ponce Deleon Dr
Palm Coast, FL 32164-4910

Phone

(386) 586-5654

Fax

(386) 586-5440

NPI assigned

Jan 7, 2017

Last updated

Jan 7, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Margaret McLarty

Title

Chief Financial Officer

Phone

(386) 679-4867

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1483747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483747200000",
    "number": "1427594944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 PONCE DELEON DR",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321644910",
            "telephone_number": "386-586-5654",
            "fax_number": "386-586-5440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 PONCE DELEON DR",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321644910",
            "telephone_number": "386-586-5654",
            "fax_number": "386-586-5440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDEVILLE MANOR HEALTH SYSTEMS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-07",
        "last_updated": "2017-01-07",
        "status": "A",
        "authorized_official_last_name": "MCLARTY",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "386-679-4867"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "00000000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "676845896",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monika Malec
• Sarah Genevieve Malinowski
• Martha Malmberg, LMT
• Jemima Malvoisin
• Ereka Manangan, PHARMD
• Christopher Robert Manees, M.D.
• Michael Mangaroo, HIS
• Manne & Borer Endodontics and Microsurgery PL
• Lawrence Michael Mantovani, RD/LDN
• Mara Grace Counseling, LLC

• Assisted Living Facility (Mental Illness) in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Assisted Living Facility (Mental Illness) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2017; 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.