Healthcare Provider Details

I. General information

NPI: 1437565348
Provider Name (Legal Business Name): GRAND OAKS OF JENSEN BEACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NW JENSEN BEACH BLVD
JENSEN BEACH FL
34957-4486
US

IV. Provider business mailing address

2400 SE MONTEREY RD SUITE # 300
STUART FL
34996-3351
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-1844
  • Fax: 772-286-8758
Mailing address:
  • Phone: 772-286-1844
  • Fax: 772-286-8753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: LAURIE H ALLEN
Title or Position: ALF ADMINISTRATOR
Credential:
Phone: 772-286-1844