Peterson Assisted Living Facility

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL8638 Issued in FL

Legal business name

PETERSON ASSISTED LIVING FACILITY

Practice address

1622 Silver St
Jacksonville, FL 32206-4446

Phone

(904) 356-3022

Fax

(904) 350-9165

NPI assigned

May 29, 2013

Last updated

May 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

Ms. Laverne Jackson

Title

Director of Operation

Phone

(904) 356-3922

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1369785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369785600000",
    "number": "1447697628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1622 SILVER ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322064446",
            "telephone_number": "904-356-3022",
            "fax_number": "904-350-9165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1622 SILVER ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322064446",
            "telephone_number": "904-356-3022",
            "fax_number": "904-350-9165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON ASSISTED LIVING FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-29",
        "last_updated": "2013-05-29",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "LAVERNE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATION",
        "authorized_official_telephone_number": "904-356-3922",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL8638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140750300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anne M Petersen, PA
• Audrey Petersen, CCC-SLP
• Beyonce Petersen
• Courtney Petersen, MD
• John M Petersen, D.O
• Cheyenne W Peterson-Gurak, COTA
• Shilonda Peterson-Jackson
• Anna Peterson
• Brianne Luisa Peterson, ARNP
• Caleb Peterson, D.O

• Assisted Living Facility in Jacksonville, FL
• Providers in Jacksonville, 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 May 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.