MEDICARE: WYNDHAM LAKES JACKSONVILLE 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	:	1952232886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYNDHAM LAKES JACKSONVILLE LLC

Provider Business Mailing Address
First Line	:	701 N MAIN ST
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48307-1434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10660 OLD SAINT AUGUSTINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1076
Country	:	US
Telephone Number	:	904-875-8325
Fax Number	:

Authorized Official
Title or Position	:	FINANCIAL OFFICER
Name	:	GEOFFREY GANE
Credential	:
Telephone Number	:	904-262-4600

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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