Healthcare Provider Details

I. General information

NPI: 1700558947
Provider Name (Legal Business Name): FOXCARE AT LAKESIDE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11411 ARMSDALE RD
JACKSONVILLE FL
32218-3311
US

IV. Provider business mailing address

2380 SADLER RD STE 201
FERNANDINA BEACH FL
32034-0415
US

V. Phone/Fax

Practice location:
  • Phone: 904-714-3793
  • Fax: 904-714-3799
Mailing address:
  • Phone: 904-321-1909
  • Fax: 904-321-1790

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: MRS. BETSY ANNE MEAD
Title or Position: CHIEF OPERATING OFFICER
Credential: RN, MSN, MBA
Phone: 813-758-9263