SELAH - FOREST LAKE MANOR, LLC (NPI# 1316281215) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316281215 |
| Entity Type | Organization |
| Organization Name | SELAH - FOREST LAKE MANOR, LLC |
| Other Organization Name | FOREST LAKE MANOR |
| Practice Address |
252 Forest Lake Blvd Daytona Beach FL 32119-8106 |
| Practice Telephone | 3867607174 |
| Practice Fax Number | 3867607812 |
| Mailing Telephone | 3867607174 |
| Mailing Fax Number | 3867607812 |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |
| Authorized Official Name | MR. ALAN DANIEL PARRISH (MANAGER) |
| Authorized Official Telephone | 9045431818 |
| Is Organization Subpart | Y |
| Parent Organization Name | SELAH SENIORCARE II |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | AL8869 | FL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 003453400 | 05 |
| Other Name | Type Code |
|---|---|
| Forest Lake Manor | Doing Business As Name - Organization |
| Street Address |
252 FOREST LAKE BLVD |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32119-8106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134675234 | Magnola Manor At Daytona Beach, LLC | Assisted Living Facility | 252 Forest Lake Blvd, Daytona Beach, FL 32119-8106 | 2016-08-29 |
| 1073924296 | Veritas Incare, LLC | Assisted Living Facility | 252 Forest Lake Blvd, Daytona Beach, FL 32119-8106 | 2014-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710509476 | Peaceful Healing Solutions, LLC | Social Worker | 1655 Restarrick Ave, South Daytona, FL 32119 | 2020-05-15 |
| 1124570585 | Kunning Li | Acupuncturist | 2135 S Ridgewood Ave, South Daytona, FL 32119 | 2016-11-01 |
| 1720451040 | Tyler M Mckinniss | Chiropractor | 1614 S Ridgewood Ave Ste 200, South Daytona, FL 32119 | 2015-11-09 |
| 1821428954 | Jesse Robert Hodges Jr. | Chiropractor | 1780 S Nova Rd Ste 4, South Daytona, FL 32119 | 2013-11-27 |
| 1831347350 | Pamela Marie Lavigna | Counselor | 1635 S. Ridgewood Ave, Suite 225, South Daytona, FL 32119 | 2008-09-09 |
| 1922214279 | Karen Sue Pulaski | Physical Therapist | 401 Venture Ave. Suite C, South Daytona, FL 32119 | 2007-05-15 |
| 1245369180 | Cathryn C Cucchiaro | Marriage & Family Therapist | 2001 S Ridgewood Ave, South Daytona, FL 32119 | 2007-03-05 |
| 1629136775 | Dennis Andrew Kuack | Dentist | 2644 S Ridgewood Ave, South Daytona, FL 32119 | 2006-12-04 |
| 1639246630 | Robert J Amara | Chiropractor | 2750 S Ridgewood Ave #c, South Daytona, FL 32119 | 2006-11-29 |
| 1306910385 | Filutowski Eye Institute Pa | Clinic/Center | 110 Yorktowne Drive, Daytona Beach, FL 32119 | 2006-11-20 |
| Find all providers in zip 32119 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104436443 | Baywood Meadows Assisted Living | Assisted Living Facility | 105 Baywood Dr, Daytona Beach, FL 32117-4601 | 2020-08-02 |
| 1912323056 | Editha Ignacio | Assisted Living Facility | 1636 E Shangri La Dr, Daytona Beach, FL 32119-1520 | 2014-03-13 |
| 1194140509 | Senior Life LLC | Assisted Living Facility | 619 Orange Ave, Daytona Beach, FL 32114-4786 | 2014-02-20 |
| 1275957276 | Isabelle Berber | Assisted Living Facility | 1249 Suwanee Rd, Daytona Beach, FL 32114-5918 | 2014-02-11 |
| 1942624366 | Justina Threadgill | Assisted Living Facility | 1312 Mardrake Rd, Daytona Beach, FL 32114-5940 | 2014-02-05 |
| 1912337866 | Compassion In Healthcare Inc | Assisted Living Facility | 700 Beville Rd, Daytona Beach, FL 32114-5924 | 2013-11-13 |
| 1013345883 | Kist Alf, Inc | Assisted Living Facility | 1516 Carmen Avenue, Daytona Beach, FL 32117 | 2013-10-14 |
| 1306180724 | Lakewood Park Investments Inc | Assisted Living Facility | 1220 Jimmy Ann Dr, Daytona Beach, FL 32117-3818 | 2012-11-26 |
| 1699036285 | Shady Oaks Rest Home Inc. | Assisted Living Facility | 1208 Kennedy Rd, Daytona Beach, FL 32117 | 2012-05-31 |
| 1437266350 | The Place At Daytona Beach, Inc. | Assisted Living Facility | 570 National Health Care Dr, Daytona Beach, FL 32114-1494 | 2006-08-24 |
| Find all providers in DAYTONA BEACH | ||||
| City | DAYTONA BEACH |
| Zip Code | 32119 |
Please comment or provide details below to improve the information on SELAH - FOREST LAKE MANOR, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.