=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255784609
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J & G FLORIDA ENTERPRISES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2016
-----------------------------------------------------
Last Update Date | 07/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6102 SAND PINES ESTATES BLVD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-7760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-207-0511
-----------------------------------------------------
Fax | 321-207-0511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2221 LEE RD STE 13
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32789-1864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-740-8815
-----------------------------------------------------
Fax | 407-740-6678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. JOHN MORRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-740-8815
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL11960
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------