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General NPI Number Information
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NPI Number | 1659448306
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Entity Type | Organization
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Legal Business Name | CARE CENTERS OF NASSAU, LLC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 10/09/2009
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Provider Practice Location Address
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Address Line | 95146 HENDRICKS RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034
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Country | US
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Telephone | 904-261-5518
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Fax | 904-261-5517
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Provider Business Mailing Address
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Address Line | 95146 HENDRICKS RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034
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Country | US
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Telephone | 904-261-5518
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Fax | 904-261-5517
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SHARON JAMISON
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Credential | RN
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Telephone | 904-261-5518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 4010096
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 40950956
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 028539100
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 40950955
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License Number State | FL
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