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NPI Code Detail

MEDICARE: NORTH JACKSONVILLE OPCO LLC

MEDICARE: NORTH JACKSONVILLE OPCO 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1205354180
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH JACKSONVILLE OPCO LLC
Provider Business Mailing Address
First Line : 480 FENTRESS BLVD STE H
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32114-1237
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12740 LANIER RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32226-1704
Country : US
Telephone Number : 904-757-2548
Fax Number :
Authorized Official
Title or Position : CORPORATE FINANCE
Name : CAMERON MARSH
Credential :
Telephone Number : 386-255-1054
Provider Enumeration Date : 08/31/2017
Last Update Date : 08/31/2017

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Directions to “NORTH JACKSONVILLE OPCO LLC ” Practice Location

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