Basic Information
| Provider Information | |||||||||
| NPI: | 1790153401 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEMORIAL HEALTH SYSTEMS INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FLORIDA HOSPITAL MEMORIAL & MEDICAL CENTER & FH OCEANSIDE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 MEMORIAL MEDICAL PKWY | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321175167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862316000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 264 S ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | ORMOND BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321768149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3869434522 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2015 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | DOMAYER | ||||||||
| AuthorizedOfficialFirstName: | CORY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3862313909 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 4201 | FL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.