Healthcare Provider Details

I. General information

NPI: 1619990538
Provider Name (Legal Business Name): ORANGE PARK FACILITY OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 KINGSLEY AVE
ORANGE PARK FL
32073-4631
US

IV. Provider business mailing address

1215 KINGSLEY AVE
ORANGE PARK FL
32073-4631
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-8922
  • Fax: 904-264-2253
Mailing address:
  • Phone: 904-269-8922
  • Fax: 904-264-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1016095
License Number StateFL

VIII. Authorized Official

Name: CRAIG E ROBINSON
Title or Position: MANAGER
Credential:
Phone: 407-215-9800