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General NPI Number Information
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NPI Number | 1710305586
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Entity Type | Organization
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Legal Business Name | TERRACE OF JACKSONVILLE LLC
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 10680 OLD SAINT AUGUSTINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-1000
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Country | US
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Telephone | 904-268-4953
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Fax | 904-268-3431
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Provider Business Mailing Address
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Address Line | 10680 OLD SAINT AUGUSTINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-1000
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Country | US
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Telephone | 904-268-4953
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Fax | 904-268-3431
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISTY DEGROSS
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Credential |
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Telephone | 904-268-4953
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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 | SNF13060961
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License Number State | FL
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