NPIMap

Organization Active NPI

Florida Department of Veterans' Affairs

Doing business as Clyde E. Lassen State Veterans' Nursing Home

  • Skilled Nursing Facility
  • St Augustine, FL
National Provider Identifier
1124336268
Registry record updated Jul 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
314000000X Issued in FL
Legal business name
FLORIDA DEPARTMENT OF VETERANS' AFFAIRS
Doing business as
Clyde E. Lassen State Veterans' Nursing Home
Practice address
4650 State Road 16
St Augustine, FL 32092-0600
Phone
(904) 940-2193
NPI assigned
Sep 23, 2010
Last updated
Jul 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2026

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

Authorized official

Name
Ms. Claudia R. Day
Title
Program Director, Fdva
Phone
(727) 518-3203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 314000000X FL Primary

Addresses

Primary practice location

4650 State Road 16
St Augustine, FL 32092-0600

Mailing address

4650 State Road 16
St Augustine, FL 32092-0600
Phone (904) 940-2193

Other names 2

  • Clyde E. Lassen State Veterans' Nursing Home Doing business as
  • Clyde E. Lasses State Veterans Nursing Home Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101122000638 FL Part A Provider - Skilled Nursing Facility 5698686608 Practice locations: St Augustine, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124336268. Details of each certification follow.

Skilled nursing facility certification: CCN 106088

Legal name
FLORIDA DEPARTMENT OF VETERANS AFFAIRS
Doing business as
CLYDE E LASSEN STATE VETERANS NURSING HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 4, 2011
Last certification
Sep 8, 2023
Beds
120
Ownership / control type
State
Multi-facility organization
Florida Department of Veterans Affairs
Organization structure
GovernmentProprietary
Enrollment address
4650 State Road 16
Clyde E Lassen State Veterans Nursing
St Augustine, FL 32092-0600
Nursing home name
CLYDE E LASSEN STATE VETERANS NURSING HOME
Affiliated entity
FLORIDA DEPARTMENT OF VETERANS' AFFAIRS

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Clyde E Lassen State Veterans Nursing HomeCCN 106088 · All quality measures
Overall star rating
4 of 5
Health inspections
5 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Government - State
Certified
Mar 4, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120113.8 residents per day on average
Chain
Florida Department of Veterans' Affairs7 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Emory L Bennett VA Pharmacy12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Individual Trustee of the SNF Dec 9, 2024
Adp of the SNF Dec 9, 2024
Indirect Ownership Interest Dec 9, 2024
Cattibell Rodriguez Individual Operational/Managerial Control Aug 18, 2024
Adp of the SNF Jun 1, 2014
Carlos M Sanchez Individual Adp of the SNF Mar 10, 2025
Florida Department of Veterans Affairs Organization, St Augustine, FL Medical provider/supplier 5% Or Greater Direct Ownership Interest Sep 1, 2010 100%
Alfred Carter Individual Corporate DirectorChief of Staff Nov 28, 2011
Adp of the SNF Nov 28, 2011

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Emory L. Bennett State Veterans' Nursing HomeDaytona Beach, FL, CCN 105840 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 18, 2014
Douglas Jacobson State Veterans' Nursing HomePort Charlotte, FL, CCN 106059 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2004
Clifford Chester Sims State Veterans' Nursing HomePanama City, FL, CCN 106056 Skilled nursing facility Direct Ownership Interest (100%) Aug 1, 2003
Baldermo Lopez State Veterans' Nursing HomeLand O Lakes, FL, CCN 106006 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1999
Florida Department of Veterans AffairsPort St Lucie, FL, CCN 686128 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 30, 2022
Florida Department of Veterans AffairsOrlando, FL, CCN 106151 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2023

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1285200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783468800000",
    "number": "1124336268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 STATE ROAD 16",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320920600",
            "telephone_number": "904-940-2193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 STATE ROAD 16",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320920600",
            "telephone_number": "904-940-2193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DEPARTMENT OF VETERANS' AFFAIRS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-23",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A",
        "authorized_official_last_name": "DAY",
        "authorized_official_first_name": "CLAUDIA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR, FDVA",
        "authorized_official_telephone_number": "727-518-3203",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "314000000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clyde E. Lassen State Veterans' Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clyde E. Lasses State Veterans Nursing Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.