Healthcare Provider Details

I. General information

NPI: 1083791263
Provider Name (Legal Business Name): AVANTE VILLA AT JACKSONVILLE BEACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 SEABREEZE AVE
JACKSONVILLE BEACH FL
32250-3365
US

IV. Provider business mailing address

5900 LAKE ELLENOR DR STE 700
ORLANDO FL
32809-4643
US

V. Phone/Fax

Practice location:
  • Phone: 904-249-7421
  • Fax: 904-249-8208
Mailing address:
  • Phone: 407-216-0101
  • Fax: 407-318-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF10270961
License Number StateFL

VIII. Authorized Official

Name: KIMBERLY L. BIEGASIEWICZ
Title or Position: PRESIDENT
Credential:
Phone: 407-216-0101