MEDICARE: PERMA CARE ASSISTED LIVING FACILITY, 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	310400000X	Assisted Living Facility	AL12765	FL

General Provider Information

NPI Number	:	1699149757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERMA CARE ASSISTED LIVING FACILITY, LLC

Provider Business Mailing Address
First Line	:	7226 EUDINE DR S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2633
Country	:	US
Telephone Number	:	904-723-1885
Fax Number	:

Provider Business Practice Location Address
First Line	:	7226 EUDINE DR S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2633
Country	:	US
Telephone Number	:	904-723-1885
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. PERMA L MCKENZIE
Credential	:
Telephone Number	:	904-731-6500

Provider Enumeration Date	:	11/30/2015
Last Update Date	:	04/04/2017

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