Healthcare Provider Details

I. General information

NPI: 1487015004
Provider Name (Legal Business Name): ORETGA ADULT LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5622 101ST ST
JACKSONVILLE FL
32210-8024
US

IV. Provider business mailing address

6817 ROJO CT
JACKSONVILLE FL
32210-4964
US

V. Phone/Fax

Practice location:
  • Phone: 904-535-9302
  • Fax:
Mailing address:
  • Phone: 904-535-9302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CORY COLEMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 904-535-9302