Provider Demographics
NPI:1679915995
Name:NORMANDY MANOR
Entity type:Organization
Organization Name:NORMANDY MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOVELYN
Authorized Official - Middle Name:LAO
Authorized Official - Last Name:BELDIA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:727-797-9461
Mailing Address - Street 1:1103 NORMANDY RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-4825
Mailing Address - Country:US
Mailing Address - Phone:727-797-9461
Mailing Address - Fax:727-723-1524
Practice Address - Street 1:1654 MIDNIGHT PASS WAY
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1820
Practice Address - Country:US
Practice Address - Phone:727-797-9461
Practice Address - Fax:727-723-1524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-28
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5194310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692468900Medicaid
FL140638800Medicaid