Phoenix Healthcare Properties of Mandarin, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF13060961 Issued in FL

Legal business name

PHOENIX HEALTHCARE PROPERTIES OF MANDARIN, LLC

Doing business as

Southlake Nursing and Rehabilitation Center

Practice address

10680 Saint Augustine Road
Jacksonville, FL 32257-1000

Phone

(904) 268-4953

NPI assigned

Jul 8, 2006

Last updated

Dec 1, 2009By 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. Dion R. Sena

Title

Managing Member

Phone

(305) 759-4046

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Southlake Nursing and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259625600000",
    "number": "1538192208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 NE 89TH STREET",
            "city": "EL PORTAL",
            "state": "FL",
            "postal_code": "331383010",
            "telephone_number": "305-759-4046",
            "fax_number": "305-759-4056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10680 SAINT AUGUSTINE ROAD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322571000",
            "telephone_number": "904-268-4953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HEALTHCARE PROPERTIES OF MANDARIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2009-12-01",
        "status": "A",
        "authorized_official_last_name": "SENA",
        "authorized_official_first_name": "DION",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "305-759-4046",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF13060961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031237100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS INSURANCE",
            "identifier": "L69",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southlake Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Phoenix Therapeutic Services, Inc
• Ava E Phoenix, M.D.
• Davong David Phrathep, DO
• Hong Phung

• Skilled Nursing Facility in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2009; 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.