Provider Demographics
NPI:1962142646
Name:SWAN AT LAKE CONWAY ALF
Entity type:Organization
Organization Name:SWAN AT LAKE CONWAY ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENEYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TEFERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-946-4116
Mailing Address - Street 1:3714 SAINT MORITZ ST
Mailing Address - Street 2:
Mailing Address - City:BELLE ISLE
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1135
Mailing Address - Country:US
Mailing Address - Phone:410-946-4116
Mailing Address - Fax:
Practice Address - Street 1:3714 SAINT MORITZ ST
Practice Address - Street 2:
Practice Address - City:BELLE ISLE
Practice Address - State:FL
Practice Address - Zip Code:32812-1135
Practice Address - Country:US
Practice Address - Phone:410-946-4116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility