Beauclerc Manor Health Care Associates LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1047096 Issued in FL

Legal business name

BEAUCLERC MANOR HEALTH CARE ASSOCIATES LLC

Practice address

9355 San Jose Blvd
Jacksonville, FL 32257-5503

Phone

(904) 739-0877

Fax

(904) 448-9253

NPI assigned

May 24, 2006

Organization subpart

No

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

Authorized official

Name

Gwendolyn S. Gamel

Title

Manager

Phone

(904) 739-0877

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• San Jose Health and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369526400000",
    "number": "1134174451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9355 SAN JOSE BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322575503",
            "telephone_number": "904-739-0877",
            "fax_number": "904-448-9253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9355 SAN JOSE BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322575503",
            "telephone_number": "904-739-0877",
            "fax_number": "904-448-9253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUCLERC MANOR HEALTH CARE ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2013-05-26",
        "status": "A",
        "authorized_official_last_name": "GAMEL",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "904-739-0877"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1047096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025205100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Jose Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anne H Beattie, AUD
• Brittany Beattie, LMHC
• Taylor Beatty
• Leslie Beaty, APRN
• Elyse D Beaubrun, ARNP
• Jessica Beaudry
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• Beauty Call LLC

• Skilled Nursing Facility in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2013; 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.