Healthcare Provider Details

I. General information

NPI: 1528949666
Provider Name (Legal Business Name): PINCKNEY ESTATES ASSISTED LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-8930
US

IV. Provider business mailing address

1823 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-8930
US

V. Phone/Fax

Practice location:
  • Phone: 904-226-1817
  • Fax:
Mailing address:
  • Phone: 904-226-1817
  • 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 Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: BRIAN PINCKNEY
Title or Position: DIRECTOR
Credential:
Phone: 904-226-1817