MEDICARE: ALL SAINTS NURSING HOME & REHAB. CENTER, 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	314000000X	Skilled Nursing Facility	SNF1007096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41601	OTHER	FL	AHCA
2	K6Q	OTHER	FL	BLUE CROSS & BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942298849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL SAINTS NURSING HOME & REHAB. CENTER, INC.

Provider Business Mailing Address
First Line	:	5888 BLANDING BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-1927
Country	:	US
Telephone Number	:	904-772-1220
Fax Number	:	904-772-6334

Provider Business Practice Location Address
First Line	:	5888 BLANDING BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-1927
Country	:	US
Telephone Number	:	904-772-1220
Fax Number	:	904-772-6334

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. CONNIE MICHELLE O'DONNELL
Credential	:
Telephone Number	:	904-772-1220

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	02/09/2010

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