NPIMap

Organization Active NPI

Jacksonville I Enterprises LLC

Doing business as The Trinity Assisted Living of Jacksonville

  • Assisted Living Facility
  • Jacksonville, TX
National Provider Identifier
1053690818
Registry record updated Aug 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
JACKSONVILLE I ENTERPRISES LLC
Doing business as
The Trinity Assisted Living of Jacksonville
Practice address
131 Zimmerman Dr.
Jacksonville, TX 75766-0131
Phone
(903) 283-1208
Fax
(845) 770-3308
NPI assigned
Aug 11, 2011
Last updated
Aug 11, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2011

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

Authorized official

Name
Gary Blake
Title
Managing Member
Phone
(817) 348-8841

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

131 Zimmerman Dr.
Jacksonville, TX 75766-0131

Mailing address

131 Zimmerman Dr.
Jacksonville, TX 75766-0131
Phone (903) 283-1208

Other names 1

  • The Trinity Assisted Living of Jacksonville Doing business as

National Provider Directory

National Provider Directory

Locations

131 Zimmerman St
Jacksonville, TX 75766
Phone (903) 283-1208

NPI Registry JSON

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

{
    "created_epoch": "1313020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313020800000",
    "number": "1053690818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 ZIMMERMAN DR.",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757660131",
            "telephone_number": "903-283-1208",
            "fax_number": "845-770-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 ZIMMERMAN DR.",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757660131",
            "telephone_number": "903-283-1208",
            "fax_number": "845-770-3308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE I ENTERPRISES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-11",
        "last_updated": "2011-08-11",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "817-348-8841"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Trinity Assisted Living of Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; 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.