MEDICARE: RIGHT TIME RIGHT PLACE 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1720683972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIGHT TIME RIGHT PLACE LLC

Provider Business Mailing Address
First Line	:	6140 CLEVELAND RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-1904
Country	:	US
Telephone Number	:	904-766-7888
Fax Number	:	904-766-7886

Provider Business Practice Location Address
First Line	:	6140 CLEVELAND RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-1904
Country	:	US
Telephone Number	:	904-766-7885
Fax Number	:	904-766-7886

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL ANTAWIN DENTON
Credential	:
Telephone Number	:	904-766-7885

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/18/2020

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Directions to “RIGHT TIME RIGHT PLACE LLC ” Practice Location

Language	Start Address	Practice Location

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