NPIMap

Organization Active NPI

San Juan Retirement Home

  • Alzheimer Center (Dementia Center)
  • Jacksonville, FL
National Provider Identifier
1053656199
Registry record updated Nov 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Alzheimer Center (Dementia Center)Taxonomy code 311500000X
License
9587 Issued in FL
Legal business name
SAN JUAN RETIREMENT HOME
Practice address
6561 San Juan Ave
Jacksonville, FL 32210-2857
Phone
(904) 695-9605
Fax
(904) 693-1973
NPI assigned
Nov 29, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2012

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

Authorized official

Name
Elvira Chua Demdam
Title
Alf Administrator
Phone
(904) 695-9605

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Alzheimer Center (Dementia Center) 311500000X 9587 FL Primary

Addresses

Primary practice location

6561 San Juan Ave
Jacksonville, FL 32210-2857

Mailing address

6561 San Juan Ave
Jacksonville, FL 32210-2857
Phone (904) 695-9605

National Provider Directory

National Provider Directory
Tax ID family
San Juan Retirement Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1354147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354147200000",
    "number": "1053656199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6561 SAN JUAN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322102857",
            "telephone_number": "904-695-9605",
            "fax_number": "904-693-1973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6561 SAN JUAN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322102857",
            "telephone_number": "904-695-9605",
            "fax_number": "904-693-1973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN RETIREMENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-29",
        "last_updated": "2012-11-29",
        "status": "A",
        "authorized_official_last_name": "DEMDAM",
        "authorized_official_first_name": "ELVIRA",
        "authorized_official_middle_name": "CHUA",
        "authorized_official_title_or_position": "ALF ADMINISTRATOR",
        "authorized_official_telephone_number": "904-695-9605"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "FL",
            "license": "9587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; 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.