Agnes Street Home for the Elderly

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL5745 Issued in FL

Legal business name

AGNES STREET HOME FOR THE ELDERLY

Practice address

1346 Agnes St
Jacksonville, FL 32208-3302

Phone

(904) 766-7651

Fax

(904) 766-7668

NPI assigned

May 31, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Atakelte Admasu

Title

Owner/Administrator

Phone

(904) 766-7651

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369958400000",
    "number": "1275970204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1346 AGNES ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322083302",
            "telephone_number": "904-766-7651",
            "fax_number": "904-766-7668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1346 AGNES ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322083302",
            "telephone_number": "904-766-7651",
            "fax_number": "904-766-7668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGNES STREET HOME FOR THE ELDERLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-31",
        "last_updated": "2013-05-31",
        "status": "A",
        "authorized_official_last_name": "ADMASU",
        "authorized_official_first_name": "ATAKELTE",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "904-766-7651",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL5745",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142605200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shealy Aghamalian, PA-C
• Aging at Home LLC
• Aging Grace Enterprises LLC
• Aging Grace LLC
• Danielle Rae Agnello
• Concepcion Latoza Agnila, M.D.
• Deogracias Remandaban Agnila Jr., NP-C
• Agr Multiservices Inc
• Agr Transportation, LLC
• Mario Agrait Bertran, MD

• All providers in Jacksonville, FL
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.