Healthcare Provider Details

I. General information

NPI: 1972593390
Provider Name (Legal Business Name): INNOVATIVE HEALTH CARE PROPERTIES D B A SUMMER BROOK HEALTH CARE CENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 08/22/2020
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: 904-768-1506
  • Fax: 904-766-1772
Mailing address:
  • Phone: 904-768-1506
  • Fax: 904-766-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1132096
License Number StateFL

VIII. Authorized Official

Name: MR. DEWAYNE K HARVEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-768-1506