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General NPI Number Information
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NPI Number | 1700855939
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE EXTENDED CARE, LLC
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 4325 SOUTHPOINT BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6166
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Country | US
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Telephone | 904-245-7620
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Fax | 904-281-9956
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Provider Business Mailing Address
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Address Line | 4325 SOUTHPOINT BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6166
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Country | US
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Telephone | 904-245-7620
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Fax | 904-281-9956
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Authorized Official
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Title or Position | BOOKKEEPER
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Name | DONNA J MARSH
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Credential |
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Telephone | 380-255-1054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 130471028
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License Number State | FL
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