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General NPI Number Information
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NPI Number | 1952396269
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Entity Type | Organization
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Legal Business Name | NORTHERN JACKSONVILLE ENTERPRISE, LLC
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 12740 LANIER RD
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City | JACKSONVILLE
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State | FL
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Zip | 32226-1704
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Country | US
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Telephone | 904-757-0600
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Fax | 904-757-7047
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Provider Business Mailing Address
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Address Line | 12740 LANIER RD
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City | JACKSONVILLE
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State | FL
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Zip | 32226-1704
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Country | US
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Telephone | 904-757-0600
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Fax | 904-757-7047
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Authorized Official
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Title or Position | REIMBURSEMENT
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Name | MR. NELSON ROBAINA JR.
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Credential |
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Telephone | 305-864-9191
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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 | SNF12880962
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License Number State | FL
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