Healthcare Provider Details

I. General information

NPI: 1386768570
Provider Name (Legal Business Name): OSPREY VILLAGE AT AMELIA ISLAND PLANTATION, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 OSPREY VILLAGE DR
AMELIA ISLAND FL
32034-4962
US

IV. Provider business mailing address

76 OSPREY VILLAGE DR
AMELIA ISLAND FL
32034-4962
US

V. Phone/Fax

Practice location:
  • Phone: 904-277-3337
  • Fax:
Mailing address:
  • Phone: 904-277-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number9197
License Number StateFL

VIII. Authorized Official

Name: KATHY LOWE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 904-277-3337