NPIMap

Organization Active NPI

Hidden Oaks Alf, Inc

Doing business as The Susan Rewis House

  • Assisted Living Facility
  • Jennings, FL
National Provider Identifier
1376896555
Registry record updated Dec 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
HIDDEN OAKS ALF, INC
Doing business as
The Susan Rewis House
Practice address
7216 NW 22ND Dr
Jennings, FL 32053-2351
Phone
(386) 938-2097
Fax
(386) 938-2636
NPI assigned
Oct 24, 2012
Last updated
Dec 28, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
HIDDEN OAKS ALF, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 28, 2022

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

Authorized official

Name
Ms. Wanda M. Law, MASTERS OF EDUCATIONNPI 1962811620
Title
Owner/Administrator
Phone
(386) 938-1149

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X NU Primary

Addresses

Primary practice location

7216 NW 22ND Dr
Jennings, FL 32053-2351

Mailing address

PO Box 180
Jennings, FL 32053-0180
Phone (386) 938-2097

Other identifiers 1

IdentifierTypeStateIssuer
693600801MedicaidFL

Other names 1

  • The Susan Rewis House Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hidden Oaks Alf Inc5 organizations share this tax ID, including this one
Part of
Hidden Oaks Alf Inc

Other organizations with this tax ID 4

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672185600000",
    "number": "1376896555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 180",
            "city": "JENNINGS",
            "state": "FL",
            "postal_code": "320530180",
            "telephone_number": "386-938-2097",
            "fax_number": "386-938-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7216 NW 22ND DR",
            "city": "JENNINGS",
            "state": "FL",
            "postal_code": "320532351",
            "telephone_number": "386-938-2097",
            "fax_number": "386-938-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIDDEN OAKS ALF, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HIDDEN OAKS ALF, INC",
        "enumeration_date": "2012-10-24",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A",
        "authorized_official_last_name": "LAW",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "386-938-1149",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MASTERS OF EDUCATION"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "693600801",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Susan Rewis House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jennings, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; 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.