Healthcare Provider Details

I. General information

NPI: 1104718246
Provider Name (Legal Business Name): P&R ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9032 3RD AVE
JACKSONVILLE FL
32208
US

IV. Provider business mailing address

9032 3RD AVE
JACKSONVILLE FL
32208
US

V. Phone/Fax

Practice location:
  • Phone: 904-480-2007
  • Fax:
Mailing address:
  • Phone: 904-480-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: PAMELA WALKER
Title or Position: OWNER/ OPERATOR
Credential:
Phone: 904-480-2007