St. Thomas Manor, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL1063 Issued in FL

Legal business name

ST. THOMAS MANOR, INC.

Practice address

1110 SW 40TH Ave
Plantation, FL 33317-4527

Phone

(954) 583-3321

NPI assigned

Oct 9, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Mathew Jacob

Title

President/Owner

Phone

(954) 583-3321

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1223510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223510400000",
    "number": "1023269875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 SW 40TH AVE",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333174527",
            "telephone_number": "954-583-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 SW 40TH AVE",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333174527",
            "telephone_number": "954-583-3321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. THOMAS MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-09",
        "last_updated": "2008-10-09",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "954-583-3321",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL1063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140824100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jerry Rickman Stacy, PHARMACIST (PHARM.D)
• Nicole Stanford
• Jay Harold Stanley, M.D.
• Eileen Marie Stanojevic, APRN

• Assisted Living Facility in Plantation, FL
• Providers in Plantation, 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 Oct 9, 2008; 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.