Provider Demographics
NPI:1386072858
Name:GINNYS PLACE II
Entity type:Organization
Organization Name:GINNYS PLACE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DURGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-258-2351
Mailing Address - Street 1:685 ROSSMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1963
Mailing Address - Country:US
Mailing Address - Phone:321-258-2351
Mailing Address - Fax:866-639-8798
Practice Address - Street 1:2251 TURTLE MOUND RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7650
Practice Address - Country:US
Practice Address - Phone:321-258-2351
Practice Address - Fax:866-639-8798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11473310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility