Healthcare Provider Details

I. General information

NPI: 1659419497
Provider Name (Legal Business Name): THE FANNIE E. TAYLOR HOME FOR THE AGED - TAYLOR MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 CHESTER AVE
JACKSONVILLE FL
32217-2252
US

IV. Provider business mailing address

6601 CHESTER AVE
JACKSONVILLE FL
32217-2252
US

V. Phone/Fax

Practice location:
  • Phone: 904-636-0313
  • Fax: 904-367-0021
Mailing address:
  • Phone: 904-636-0313
  • Fax: 904-367-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL7201
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberAL7201
License Number StateFL

VIII. Authorized Official

Name: MATHEW SHERBURNE
Title or Position: V.P. FINANCE & ADMINISTRATION
Credential:
Phone: 904-636-0313