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General NPI Number Information
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NPI Number | 1790772127
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Entity Type | Organization
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Legal Business Name | JOHN KNOX VILLAGE OF FLORIDA, INC.
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 830 LAKESIDE CIR
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City | POMPANO BEACH
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State | FL
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Zip | 33060-7748
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Country | US
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Telephone | 954-783-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 830 LAKESIDE CIR
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City | POMPANO BEACH
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State | FL
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Zip | 33060-7748
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Country | US
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Telephone | 954-783-4090
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Fax | 954-783-4043
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | DOUGLAS FOLSOM
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Credential |
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Telephone | 954-783-4096
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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 | SNF1258096
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License Number State | FL
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