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General NPI Number Information
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NPI Number | 1811009442
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Entity Type | Organization
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Legal Business Name | CATHEDRAL GERONTOLOGY CENTER, INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 333 E ASHLEY ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202-2709
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Country | US
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Telephone | 904-798-5300
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Fax | 904-854-7354
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Provider Business Mailing Address
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Address Line | 333 E ASHLEY ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202-2709
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Country | US
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Telephone | 904-798-5300
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Fax | 904-854-7354
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Authorized Official
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Title or Position | V.P./N.H.ADMINISTRATOR
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Name | MISS SHARON G BRWON
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Credential | N.H. ADMIN. M.S.
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Telephone | 904-798-5300
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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 | SNF1079096
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License Number State | FL
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