Golden Manor Assisted Living Facility LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GOLDEN MANOR ASSISTED LIVING FACILITY LLC

Practice address

197 NW Gwen Lake Ave
Lake City, FL 32055-3711

Phone

(386) 697-9425

NPI assigned

Aug 25, 2020

Organization subpart

No

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

Authorized official

Name

Mardell JacksonNPI 1598247009

Title

Administrator

Phone

(386) 697-9425

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mardell Jackson

  • Assisted Living Facility
  • Lake City, FL
  • NPI 1598247009
  NPD (past) Authorized official

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

{
    "created_epoch": "1598313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598313600000",
    "number": "1396358792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2666",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320562666",
            "telephone_number": "386-697-9425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "197 NW GWEN LAKE AVE",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320553711",
            "telephone_number": "386-697-9425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN MANOR ASSISTED LIVING FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-25",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MARDELL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "386-697-9425"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth L Glass, RN
• Jeffrey C. Glenn, D.O.
• Emaline Glover
• Liana Brooke Godbold, PTA
• James Nicholas Goff II, HAS
• Alex L Gonzales, MD
• Jan Kenneth Gonzales, FNP-C
• Rafael Angel Gonzalez Castro, M.D.
• Edwin Gonzalez-Navedo, MD
• Shawntavia Y Goodman

• Assisted Living Facility in Lake City, FL
• Providers in Lake City, 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 25, 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.