MEDICARE: NORTHERN JACKSONVILLE ACQUISITIONS, 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		FL
2	313M00000X	Nursing Facility/Intermediate Care Facility		FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	10-5138	OTHER	FL	MEDICARE PTAN

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	:	1538418249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN JACKSONVILLE ACQUISITIONS, LLC

Provider Business Mailing Address
First Line	:	5377 MONCRIEF RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-3159
Country	:	US
Telephone Number	:	786-207-2108
Fax Number	:	866-293-2100

Provider Business Practice Location Address
First Line	:	5377 MONCRIEF RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-3159
Country	:	US
Telephone Number	:	786-207-2108
Fax Number	:	866-293-2100

Authorized Official
Title or Position	:	OWNER/ MANAGER
Name	:	MR. MICHAEL GREENWALD
Credential	:
Telephone Number	:	786-207-2108

Provider Enumeration Date	:	09/10/2012
Last Update Date	:	12/20/2013

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Directions to “NORTHERN JACKSONVILLE ACQUISITIONS, LLC ” Practice Location

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