NPIMap

Organization Active NPI

Jeroll Care Assisted Living, LLC

  • Assisted Living Facility
  • Palm Bay, FL
National Provider Identifier
1619220324
Registry record updated Oct 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
12239 Issued in FL
Legal business name
JEROLL CARE ASSISTED LIVING, LLC
Practice address
107 Coffee St SE
Palm Bay, FL 32909-8561
Phone
(321) 266-5166
Fax
(321) 821-1525
NPI assigned
Oct 18, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2012

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

Authorized official

Name
Mrs. Jhoane Eunice Laleau, RN, BSN
Title
Administrator
Phone
(321) 266-5166

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 12239 FL Primary

Addresses

Primary practice location

107 Coffee St SE
Palm Bay, FL 32909-8561

Mailing address

107 Coffee St SE
Palm Bay, FL 32909-8561
Phone (321) 266-5166

Other identifiers 1

IdentifierTypeStateIssuer
003357400MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Jeroll Care Assisted Living 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": "1350518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350518400000",
    "number": "1619220324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 COFFEE ST SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329098561",
            "telephone_number": "321-266-5166",
            "fax_number": "321-821-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 COFFEE ST SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329098561",
            "telephone_number": "321-266-5166",
            "fax_number": "321-821-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEROLL CARE ASSISTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-18",
        "last_updated": "2012-10-18",
        "status": "A",
        "authorized_official_last_name": "LALEAU",
        "authorized_official_first_name": "JHOANE",
        "authorized_official_middle_name": "EUNICE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "321-266-5166",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "12239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003357400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; 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.