Provider Demographics
NPI:1548507866
Name:FESTA ENTERPRISES INC.
Entity type:Organization
Organization Name:FESTA ENTERPRISES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:J
Authorized Official - Last Name:FESTA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:239-565-3846
Mailing Address - Street 1:13860 LILY PAD CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1825
Mailing Address - Country:US
Mailing Address - Phone:239-565-3846
Mailing Address - Fax:239-481-9919
Practice Address - Street 1:6722 WINKLER RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7204
Practice Address - Country:US
Practice Address - Phone:239-433-5553
Practice Address - Fax:239-481-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7353310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680876000OtherMEDICAID WAIVER