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General NPI Number Information
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NPI Number | 1447639216
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Entity Type | Organization
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Legal Business Name | ANAM PARC, LLC.
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 4294 TANGLEWILDE DR S
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City | JACKSONVILLE
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State | FL
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Zip | 32257-6439
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Country | US
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Telephone | 904-610-6602
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Fax |
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Provider Business Mailing Address
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Address Line | 3604 CARDINAL POINT DR
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City | JACKSONVILLE
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State | FL
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Zip | 32257-5581
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Country | US
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Telephone | 904-610-6602
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Fax | 904-731-0002
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Authorized Official
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Title or Position | OWNER
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Name | JAMIE LOUISE GLAVICH
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Credential |
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Telephone | 904-610-6602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12145
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License Number State | FL
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