Healthcare Provider Details

I. General information

NPI: 1992767057
Provider Name (Legal Business Name): NAVAL CONTINUING CARE RETIREMENT FOUNDATION INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FLEET LANDING BLVD
ATLANTIC BEACH FL
32233-4599
US

IV. Provider business mailing address

1 FLEET LANDING BLVD
ATLANTIC BEACH FL
32233-4599
US

V. Phone/Fax

Practice location:
  • Phone: 904-246-9900
  • Fax: 904-246-9566
Mailing address:
  • Phone: 904-246-9900
  • Fax: 904-246-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF11510961
License Number StateFL

VIII. Authorized Official

Name: MR. JOSHUA ASHBY
Title or Position: DIRECTOR OF HEALTH CARE SERVICES
Credential: M.B.A.
Phone: 904-246-9900