Upscale Personal Care Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12575 Issued in FL

Legal business name

UPSCALE PERSONAL CARE HOME

Practice address

4375 Autumn River Road
Jacksonville, FL 32224

Phone

(904) 762-5477

Fax

(904) 239-3088

NPI assigned

Jul 1, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Regina Henderson

Title

President

Phone

(404) 693-3033

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435708800000",
    "number": "1003299603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40673",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322030673",
            "telephone_number": "904-762-5477",
            "fax_number": "904-239-3088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4375 AUTUMN RIVER ROAD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32224",
            "telephone_number": "904-762-5477",
            "fax_number": "904-239-3088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSCALE PERSONAL CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-01",
        "last_updated": "2015-07-01",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "REGINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-693-3033",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCA",
            "identifier": "AL12575",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.