MEDICARE: ONE HC-JENSEN BEACH 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

General Provider Information

NPI Number	:	1801349063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE HC-JENSEN BEACH LLC

Provider Business Mailing Address
First Line	:	1537 NE CEDAR ST
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957
Country	:	US
Telephone Number	:	772-332-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1537 NE CEDAR ST
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957
Country	:	US
Telephone Number	:	772-332-1000
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. JOSEPH D HUMMEL
Credential	:
Telephone Number	:	561-451-7328

Provider Enumeration Date	:	07/25/2016
Last Update Date	:	07/25/2016

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