NPIMap

Organization Active NPI

Breakwater Adult Family Care Home LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Dunnellon, FL
National Provider Identifier
1356407704
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
6905655 Issued in FL
Legal business name
BREAKWATER ADULT FAMILY CARE HOME LLC
Practice address
22699 SW Breakwater Blvd
Dunnellon, FL 34431-4039
Phone
(352) 401-7699
Fax
(352) 401-7698
NPI assigned
Dec 29, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Vince Jacobs
Title
Owner
Phone
(352) 598-0288

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 6905655 FL Primary

Addresses

Primary practice location

22699 SW Breakwater Blvd
Dunnellon, FL 34431-4039

Mailing address

22699 SW Breakwater Blvd
Dunnellon, FL 34431-4039
Phone (352) 401-7699

National Provider Directory

National Provider Directory
Tax ID family
Breakwater Adult Family Care Home LLC2 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.

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356407704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22699 SW BREAKWATER BLVD",
            "city": "DUNNELLON",
            "state": "FL",
            "postal_code": "344314039",
            "telephone_number": "352-401-7699",
            "fax_number": "352-401-7698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22699 SW BREAKWATER BLVD",
            "city": "DUNNELLON",
            "state": "FL",
            "postal_code": "344314039",
            "telephone_number": "352-401-7699",
            "fax_number": "352-401-7698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKWATER ADULT FAMILY CARE HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "VINCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-598-0288"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": "6905655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunnellon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.