Provider Demographics
NPI:1366983140
Name:MEDICAL ALLIED NURSING ACADEMY, INC.
Entity type:Organization
Organization Name:MEDICAL ALLIED NURSING ACADEMY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHIANA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BAZILE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:407-440-8696
Mailing Address - Street 1:928 SPRING LAKE SQ
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-1352
Mailing Address - Country:US
Mailing Address - Phone:407-440-8696
Mailing Address - Fax:407-440-8696
Practice Address - Street 1:750 PLAZA ORANGE BLOSSOM TRAIL
Practice Address - Street 2:SUITE 264
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805
Practice Address - Country:US
Practice Address - Phone:407-440-8696
Practice Address - Fax:407-440-8696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NR 12345311Z00000X
FL314000000X
FLP13000025575315P00000X
FL31400000X314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities