Jenlee Living Facility

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

JENLEE LIVING FACILITY

Practice address

16661 Carlton Pond St
Wimauma, FL 33598-2443

Phone

(813) 524-6736

Fax

(813) 479-6931

NPI assigned

Aug 28, 2024

Last updated

Aug 28, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Black

Title

Administrator

Phone

(813) 524-6736

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1724803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724803200000",
    "number": "1144054545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16661 CARLTON POND ST",
            "city": "WIMAUMA",
            "state": "FL",
            "postal_code": "335982443",
            "telephone_number": "813-524-6736",
            "fax_number": "813-479-6931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16661 CARLTON POND ST",
            "city": "WIMAUMA",
            "state": "FL",
            "postal_code": "335982443",
            "telephone_number": "813-524-6736",
            "fax_number": "813-479-6931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENLEE LIVING FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-28",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "813-524-6736"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; 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.