Bedrock HCS at Daytona FL LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BEDROCK HCS AT DAYTONA FL LLC

Doing business as

Indigo Palms at the Manor

Practice address

595 N Williamson Blvd
Daytona Beach, FL 32114-7185

Phone

(386) 257-4400

NPI assigned

Oct 5, 2021

Last updated

Feb 6, 2024By 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

Esther Tillim

Title

Bookeeper

Phone

(732) 328-7499

Specialties & licenses 1

Addresses

Other names 1

• Indigo Palms at the Manor Doing business as

Tax ID family

Bedrock HCS at Daytona FL 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.

• Bedrock HCS at Daytona FL LLC

  • Skilled Nursing Facility
  • Daytona Beach, FL
  • NPI 1124656202
  NPD tax ID

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

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1982376133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 AVENUE OF THE STATES STE 302",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087014592",
            "telephone_number": "732-328-7499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 N WILLIAMSON BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321147185",
            "telephone_number": "386-257-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEDROCK HCS AT DAYTONA FL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-05",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "TILLIM",
        "authorized_official_first_name": "ESTHER",
        "authorized_official_title_or_position": "BOOKEEPER",
        "authorized_official_telephone_number": "732-328-7499"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indigo Palms at the Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Olga Vladimirovna Beckwith
• Pamela Gail Bedard, MSW
• Brittany Bednov, M.D.
• Eugene Vitaly Bednov, M.D.
• Bedrock HCS at Daytona FL LLC
• Erica Beebe, OTR/L
• Lolade Beecher, DO
• Behavioral Excellence and Skill Training
• Behavioral Health Services of Florida LLC
• Victoria Bejarano, DMD

• Assisted Living Facility in Daytona Beach, FL
• Providers in Daytona 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 Feb 6, 2024; 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.