MEDICARE: BEAUCLERC MANOR HEALTH CARE ASSOCIATES LLC

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	SNF1047096	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	:	1134174451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUCLERC MANOR HEALTH CARE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	9355 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5503
Country	:	US
Telephone Number	:	904-739-0877
Fax Number	:	904-448-9253

Provider Business Practice Location Address
First Line	:	9355 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5503
Country	:	US
Telephone Number	:	904-739-0877
Fax Number	:	904-448-9253

Authorized Official
Title or Position	:	MANAGER
Name	:	GWENDOLYN S. GAMEL
Credential	:
Telephone Number	:	904-739-0877

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	05/26/2013

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