Healthcare Provider Details

I. General information

NPI: 1114488996
Provider Name (Legal Business Name): SUMMER BROOK FL SNF MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5377 MONCRIEF RD
JACKSONVILLE FL
32209-3159
US

IV. Provider business mailing address

480 FENTRESS BLVD STE H
DAYTONA BEACH FL
32114-1237
US

V. Phone/Fax

Practice location:
  • Phone: 904-768-1506
  • Fax:
Mailing address:
  • Phone:
  • 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: CAMERON MARSH
Title or Position: CORPORATE FINANCE
Credential:
Phone: 386-255-1054