Prestige Manor LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL10889 Issued in FL

Legal business name

PRESTIGE MANOR LLC

Practice address

6333 SE Babb Rd
Belleview, FL 34420-4280

Phone

(352) 307-6333

Fax

(352) 245-1748

NPI assigned

Apr 2, 2014

Organization subpart

No

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

Authorized official

Name

Carrol Dillon-Smith

Title

Owner/Administrator

Phone

(352) 307-6333

Specialties & licenses 1

Addresses

Tax ID family

Prestige Manor LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Prestige Manor LLC

  • Assisted Living Facility
  • Belleview, FL
  • NPI 1104242460
  NPD tax ID

Locations

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

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410393600000",
    "number": "1659799112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6333 SE BABB RD",
            "city": "BELLEVIEW",
            "state": "FL",
            "postal_code": "344204280",
            "telephone_number": "352-307-6333",
            "fax_number": "352-245-1748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6333 SE BABB RD",
            "city": "BELLEVIEW",
            "state": "FL",
            "postal_code": "344204280",
            "telephone_number": "352-307-6333",
            "fax_number": "352-245-1748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-02",
        "last_updated": "2014-09-11",
        "status": "A",
        "authorized_official_last_name": "DILLON-SMITH",
        "authorized_official_first_name": "CARROL",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "352-307-6333"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL10889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Edward Lorenzo Pullings Jr.
• Hailey Purdy
• Josephine C Rader, RPH
• Angelle Rankin, BCBA

• Assisted Living Facility in Belleview, FL
• Providers in Belleview, 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 Sep 11, 2014; 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.