Samson Villa of Orange Park

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12338 Issued in FL

Legal business name

SAMSON VILLA OF ORANGE PARK

Practice address

2757 Pebbleridge CT
Orange Park, FL 32065-6261

Phone

(904) 375-2011

NPI assigned

Aug 29, 2013

Last updated

Aug 29, 2013By 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

Mr. Samuel Corbett Granger II

Title

Owner/Administrator

Phone

(904) 755-8707

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1377734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377734400000",
    "number": "1285068908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2757 PEBBLERIDGE COURT",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "32065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2757 PEBBLERIDGE CT",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320656261",
            "telephone_number": "904-375-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMSON VILLA OF ORANGE PARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-29",
        "last_updated": "2013-08-29",
        "status": "A",
        "authorized_official_last_name": "GRANGER II",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "CORBETT",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "904-755-8707",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Salyer
• David Samaha, MD
• George Samaniego
• Shirli Samara, DO MBA
• Jacqueline Sampson
• Jacquatta M Samuels
• John S Sanad, RPH.
• Justine Sandberg, BCBA
• Jenny Lee Sandell, LMHC, NCC, CCMHC
• Kalinah Marianna Sanders

• Assisted Living Facility in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.