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General NPI Number Information
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NPI Number | 1467878454
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Entity Type | Organization
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Legal Business Name | HENDRIX, SMITH, & KIRBY LLC D/B/A EASTSIDE CARE ALF
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Dates
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Enumeration Date | 03/14/2014
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 152 SE DEFENDER DR
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City | LAKE CITY
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State | FL
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Zip | 32025-4990
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Country | US
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Telephone | 386-755-4487
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Fax |
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Provider Business Mailing Address
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Address Line | 152 SE DEFENDER DR
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City | LAKE CITY
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State | FL
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Zip | 32025-4990
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Country | US
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Telephone | 386-755-4487
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Fax |
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Authorized Official
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Title or Position | REGIONAL AREA ADMINISTRATOR
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Name | JESSICA MURPHY
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Credential |
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Telephone | 386-688-9318
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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 | 5425
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License Number State | FL
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