MEDICARE: SOME PLACE LIKE HOME, 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	310400000X	Assisted Living Facility	AL9738	FL

General Provider Information

NPI Number	:	1396185153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOME PLACE LIKE HOME, INC.

Provider Business Mailing Address
First Line	:	3930 NOVALINE LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-2247
Country	:	US
Telephone Number	:	904-744-8580
Fax Number	:

Provider Business Practice Location Address
First Line	:	2307 SMULLIAN TRL N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-3534
Country	:	US
Telephone Number	:	904-448-0914
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BARBARA Y TIDWELL
Credential	:
Telephone Number	:	904-744-8580

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	06/26/2013

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