Heritage Waterside

LBN: Heritage Waterside
Heritage Waterside is an health care organization with primary practice located at 3704 Cardinal Blvd , Daytona Beach Shores FL 32118-7301. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Assisted Living Facility, which is considered as the primary health care specialty. Heritage Waterside can be contacted via phone (386) 256-2015, or through Nagrani, Mark via phone (386) 256-2015.

Contact Information

Primary practice address
3704 Cardinal Blvd Daytona Beach Shores FL 32118-7301
Phone: (386) 256-2015
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Nagrani, Mark Doctor of Medicine (MD)
Phone: (386) 256-2015

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X

Profile Details

NPI number 1114501574
LBN Legal business name Heritage Waterside
DBA Doing business as
Authorized official Nagrani, Mark Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date May 11th, 2021
Last updated May 11th, 2021 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114501574 NPPES
Florida MEDICAID 109599800

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