Healthcare Provider Details

I. General information

NPI: 1316040280
Provider Name (Legal Business Name): ST CATHERINE LABOURE MANOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 STOCKTON ST
JACKSONVILLE FL
32204-4664
US

IV. Provider business mailing address

1750 STOCKTON ST
JACKSONVILLE FL
32204-4664
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-7300
  • Fax:
Mailing address:
  • Phone: 904-308-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1517096
License Number StateFL

VIII. Authorized Official

Name: SCOTT WHALEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 904-308-8194