Healthcare Provider Details

I. General information

NPI: 1538418249
Provider Name (Legal Business Name): NORTHERN JACKSONVILLE ACQUISITIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5377 MONCRIEF RD
JACKSONVILLE FL
32209-3159
US

IV. Provider business mailing address

5377 MONCRIEF RD
JACKSONVILLE FL
32209-3159
US

V. Phone/Fax

Practice location:
  • Phone: 786-207-2108
  • Fax: 866-293-2100
Mailing address:
  • Phone: 786-207-2108
  • Fax: 866-293-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. MICHAEL GREENWALD
Title or Position: OWNER/ MANAGER
Credential:
Phone: 786-207-2108