MEDICARE: THE PAVILION AT JACKSONVILLE FOR NURSING AND REHABILITATION, 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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063097921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PAVILION AT JACKSONVILLE FOR NURSING AND REHABILITATION, LLC

Provider Business Mailing Address
First Line	:	1 VALLEY GREENS DR
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11581-3634
Country	:	US
Telephone Number	:	516-865-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1771 EDGEWOOD AVE W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-3278
Country	:	US
Telephone Number	:	516-865-1500
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	RAFAEL A MOERMAN
Credential	:
Telephone Number	:	516-865-1500

Provider Enumeration Date	:	03/12/2021
Last Update Date	:	03/12/2021

Similar Medicare Providers

1871993519 — MR. JONATHAN ALCARDE GONZALES
Practice Location Address:

1771 EDGEWOOD AVE W , SUITE 6B
JACKSONVILLE, FL
32208-3278

Practice Phone: 904-768-9966
Practice Fax: 904-367-8760

1962404905 — EDGEWOOD NURSING CENTER INC
Practice Location Address:

1771 EDGEWOOD AVE W
JACKSONVILLE, FL
32208-3278

Practice Phone: 904-766-7436
Practice Fax: 904-766-5749

1912084294 — HANA CARE INC
Practice Location Address:

1771 EDGEWOOD AVE W , SUITE 6B
JACKSONVILLE, FL
32208-3278

Practice Phone: 904-768-9966
Practice Fax: 904-765-1655

1063790012 — TAMARA JACOBS P.T.
Practice Location Address:

1771 EDGEWOOD AVE W STE 6B
JACKSONVILLE, FL
32208-3278

Practice Phone: 904-768-9966
Practice Fax: 904-765-1655

1770129793 — EDGEWOOD MAXIMUS OPERATIONS LLC
Practice Location Address:

1771 EDGEWOOD AVE W
JACKSONVILLE, FL
32208-3278

Practice Phone: 904-766-7436
Practice Fax:

1831054998 — DAYAN BROWN
Practice Location Address:

7827 STEPHENSON DR
JACKSONVILLE, FL
32208-2777

Practice Phone: 904-403-4133
Practice Fax:

Directions to “THE PAVILION AT JACKSONVILLE FOR NURSING AND REHABILITATION, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.