MEDICARE: IHS OF FLORIDA AT JACKSONVILLE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	SNF1087096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033194279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IHS OF FLORIDA AT JACKSONVILLE INC

Provider Business Mailing Address
First Line	:	1650 FOURAKER RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221
Country	:	US
Telephone Number	:	904-786-8668
Fax Number	:	904-695-0166

Provider Business Practice Location Address
First Line	:	1650 FOURAKER RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221
Country	:	US
Telephone Number	:	904-786-8668
Fax Number	:	904-695-0166

Authorized Official
Title or Position	:	CEO
Name	:	MR. BRIAN REYNOLDS
Credential	:
Telephone Number	:	410-513-8738

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/16/2014

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Directions to “IHS OF FLORIDA AT JACKSONVILLE INC ” Practice Location

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