MEDICARE: JACKSONVILLE REHABILITATION AND NURSING CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10800961	OTHER	FL	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033844485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSONVILLE REHABILITATION AND NURSING CENTER LLC

Provider Business Mailing Address
First Line	:	2061 HYDE PARK RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3815
Country	:	US
Telephone Number	:	904-786-7331
Fax Number	:	904-786-4034

Provider Business Practice Location Address
First Line	:	2061 HYDE PARK RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3815
Country	:	US
Telephone Number	:	904-786-7331
Fax Number	:	904-786-4034

Authorized Official
Title or Position	:	MEMBER
Name	:	MOSHE KELMAN
Credential	:
Telephone Number	:	917-613-1662

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	10/07/2024

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