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NPI Code Detail

MEDICARE: SWEET RETREAT ASSISTED LIVING FACILITY

MEDICARE: SWEET RETREAT ASSISTED LIVING FACILITY
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
13104A0625XAssisted Living Facility (Mental Illness)AL11394FL
2310400000XAssisted Living FacilityAL11394FL

General Provider Information

NPI Number : 1053560680
Entity Type Code : Organization
Provider Name (Legal Business Name) : SWEET RETREAT ASSISTED LIVING FACILITY
Provider Business Mailing Address
First Line : 142 COTTAGE AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32206-3629
Country : US
Telephone Number : 904-354-3805
Fax Number : 904-354-3875
Provider Business Practice Location Address
First Line : 142 COTTAGE AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32206-3629
Country : US
Telephone Number : 904-354-3805
Fax Number : 904-354-3875
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. DAVID SEBASTIAN WEBBE
Credential : RN
Telephone Number : 904-476-5893
Provider Enumeration Date : 09/18/2008
Last Update Date : 09/18/2008

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Directions to “SWEET RETREAT ASSISTED LIVING FACILITY ” Practice Location

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