MEDICARE: INGLESIDE ALF HOME 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	:	1770446189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INGLESIDE ALF HOME LLC

Provider Business Mailing Address
First Line	:	1909 PERRY ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-3521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1909 PERRY ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-3521
Country	:	US
Telephone Number	:	904-686-0102
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ERA MCGILL
Credential	:
Telephone Number	:	904-239-0272

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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Directions to “INGLESIDE ALF HOME LLC ” Practice Location

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