Healthcare Provider Details

I. General information

NPI: 1073285060
Provider Name (Legal Business Name): GREEN COVE FACILITY OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 OAK ST
GREEN COVE SPRINGS FL
32043-4317
US

IV. Provider business mailing address

803 OAK ST
GREEN COVE SPRINGS FL
32043-4317
US

V. Phone/Fax

Practice location:
  • Phone: 904-284-5606
  • Fax:
Mailing address:
  • Phone: 904-284-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JARED ELLIOTT
Title or Position: MANAGER
Credential:
Phone: 407-429-6100