Healthcare Provider Details

I. General information

NPI: 1669479192
Provider Name (Legal Business Name): RIVER GARDEN HEBREW HOME FOR THE AGED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 OLD SAINT AUGUSTINE RD
JACKSONVILLE FL
32258
US

IV. Provider business mailing address

11401 OLD SAINT AUGUSTINE RD # 106
JACKSONVILLE FL
32258-4500
US

V. Phone/Fax

Practice location:
  • Phone: 904-260-1818
  • Fax: 904-260-9733
Mailing address:
  • Phone: 904-260-1818
  • Fax: 904-260-9733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberSNF1476096
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberSNF1476096
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH2050
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA299991334
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License NumberSNF1476096
License Number StateFL
# 8
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1476096
License Number StateFL

VIII. Authorized Official

Name: MAURI MIZRAHI
Title or Position: CEO
Credential: LNHA
Phone: 904-260-1818