FSL Jax Beach Tenant LLC.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

FSL JAX BEACH TENANT LLC.

Practice address

1315 2ND Ave N
Jacksonville Beach, FL 32250-3694

Phone

(904) 829-6479

NPI assigned

Aug 27, 2021

Organization subpart

No

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

Authorized official

Name

Leslie Dawn Crayton

Title

Project Manager

Phone

(417) 877-1717

Specialties & licenses 1

Addresses

Other names 1

• Beach House Assisted Living and Memory Care Doing business as

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1073280988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 E INDEPENDENCE ST STE 200",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044201",
            "telephone_number": "417-877-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 2ND AVE N",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503694",
            "telephone_number": "904-829-6479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FSL JAX BEACH TENANT LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A",
        "authorized_official_last_name": "CRAYTON",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "PROJECT MANAGER",
        "authorized_official_telephone_number": "417-877-1717"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beach House Assisted Living and Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paul Anthony Friedlin, OT,CHT
• Laura Friedman, OTR/L
• Mark S. Frisk, M.D.
• Sharon Lee Frith, P.A.-C.
• Blake Frutchey, PHARM.D.
• Karen Micheel Gabriel, MED, LMHC
• Thomas G Gaddis, MD
• Elizabeth K Gainer, LMHC
• Ruple Jayantilal Galani, M.D.
• Maedeh Ganji, MD

• Assisted Living Facility in Jacksonville Beach, FL
• Providers in Jacksonville Beach, 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 Aug 27, 2021; 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.