The Palisades at Ewu

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

THE PALISADES AT EWU

Practice address

1156 W 4TH St
Jacksonville, FL 32209-7704

Phone

(904) 610-5628

NPI assigned

Jan 24, 2025

Organization subpart

Yes

Parent organization

R.O.B. PROPERTIES LLCAs reported in NPPES

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

Authorized official

Name

Kenkenyana Roberts

Title

Ceo

Phone

(904) 610-5628

Specialties & licenses 2

Addresses

Other names 1

• The Palisades at EWU Doing business as

Part of

The Palisades at Ewu

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

{
    "created_epoch": "1737676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737676800000",
    "number": "1154133296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77007 MERRILL RD",
            "address_2": "UNIT 8309",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32277",
            "telephone_number": "904-610-5628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1156 W 4TH ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322097704",
            "telephone_number": "904-610-5628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PALISADES AT EWU",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "R.O.B. PROPERTIES LLC",
        "enumeration_date": "2025-01-24",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-20",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "KENKENYANA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-610-5628"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Palisades at EWU",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Care Home Facility in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Adult Care Home Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; 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.