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NPI Code Detail

MEDICARE: NORTHERN JACKSONVILLE ENTERPRISE, LLC

MEDICARE: NORTHERN JACKSONVILLE ENTERPRISE, 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 FacilitySNF12880962FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952396269
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHERN JACKSONVILLE ENTERPRISE, LLC
Provider Business Mailing Address
First Line : 12740 LANIER RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32226-1704
Country : US
Telephone Number : 904-757-0600
Fax Number : 904-757-7047
Provider Business Practice Location Address
First Line : 12740 LANIER RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32226-1704
Country : US
Telephone Number : 904-757-0600
Fax Number : 904-757-7047
Authorized Official
Title or Position : REIMBURSEMENT
Name : MR. NELSON ROBAINA JR.
Credential :
Telephone Number : 305-864-9191
Provider Enumeration Date : 09/13/2005
Last Update Date : 05/21/2009

Similar Medicare Providers

1588879712 — ALEIDA M. RIVERO M.A., CCC-SLP
Practice Location Address:
12740 LANIER RD
JACKSONVILLE, FL
32226-1704
Practice Phone: 904-757-0600
Practice Fax: 888-421-1025
1265837314 — LANIER TERRACE LLC
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JACKSONVILLE, FL
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Practice Fax: 305-899-0201
1205354180 — NORTH JACKSONVILLE OPCO LLC
Practice Location Address:
12740 LANIER RD
JACKSONVILLE, FL
32226-1704
Practice Phone: 904-757-2548
Practice Fax:
1932685880 — LANIER REHABILITATION CENTER LLC
Practice Location Address:
12740 LANIER RD
JACKSONVILLE, FL
32226-1704
Practice Phone: 904-757-2548
Practice Fax: 904-475-7047
1245001437 — CHRYSTAL ELIZABETH NELSON
Practice Location Address:
12740 LANIER RD
JACKSONVILLE, FL
32226-1704
Practice Phone: 904-537-2170
Practice Fax:
1669406260 — DR. HALE E HEDLEY MD
Practice Location Address:
6817 SOUTHPOINT PKWY STE 1704 , #1704
JACKSONVILLE, FL
32216-6298
Practice Phone: 904-222-8500
Practice Fax: 800-388-0270

Directions to “NORTHERN JACKSONVILLE ENTERPRISE, 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.

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