Sa-PG-Jacksonville LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1406096 Issued in FL

Legal business name

SA-PG-JACKSONVILLE LLC

Doing business as

Palm Garden of Jacksonville

Practice address

5725 Spring Park Rd
Jacksonville, FL 32216-5955

Phone

(904) 733-6954

Fax

(904) 733-4877

NPI assigned

Jun 22, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Alex Paley

Title

Coo

Phone

(914) 390-4363

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Palm Garden of Jacksonville Doing business as

Tax ID family

Palm Garden of Jacksonville2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Palm Garden of Jacksonville LLC

  • Skilled Nursing Facility
  • Jacksonville, FL
  • NPI 1831524883
  NPD tax ID

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1144226440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5725 SPRING PARK RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322165955",
            "telephone_number": "904-733-6954",
            "fax_number": "904-733-4877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5725 SPRING PARK RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322165955",
            "telephone_number": "904-733-6954",
            "fax_number": "904-733-4877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SA-PG-JACKSONVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "PALEY",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "914-390-4363",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1406096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025727300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palm Garden of Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Jul 22, 2008; 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.