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NPI Code Detail

MEDICARE: ANTHEM LAKES

MEDICARE: ANTHEM LAKES
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
1310400000XAssisted Living Facility12972

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093222515
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANTHEM LAKES
Provider Business Mailing Address
First Line : 905 ASSISI LN
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32233-2972
Country : US
Telephone Number : 904-746-7220
Fax Number :
Provider Business Practice Location Address
First Line : 905 ASSISI LN
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32233-2972
Country : US
Telephone Number : 904-746-7220
Fax Number :
Authorized Official
Title or Position : OPERATIONS LIAISON
Name : MR. JOHNPAUL LOUIS GOODE
Credential :
Telephone Number : 804-839-6946
Provider Enumeration Date : 01/05/2018
Last Update Date : 01/05/2018

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Directions to “ANTHEM LAKES ” Practice Location

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