Active NPI
Julianne Eastmond
- Adult Care Home Facility
- Lehigh Acres, FL
National Provider Identifier
1659745461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Care Home Facility
- License
- 6906763
- Practice address
- 4504 Lee Blvd
Lehigh Acres, FL 33971-1627 - Phone
- (239) 798-8764
- NPI assigned
- Nov 17, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | 6906763 | FL | Primary |
Addresses
Primary practice location
4504 Lee Blvd
Lehigh Acres, FL 33971-1627
Mailing address
4504 Lee Blvd
Lehigh Acres, FL 33971-1627
Phone (239) 798-8764
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 015293000 | Medicaid | FL | |
| 6906763 | Other | FL | AHCA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6906763 | FL | MD | Adult Care Home Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447718400000",
"number": "1659745461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4504 LEE BLVD",
"city": "LEHIGH ACRES",
"state": "FL",
"postal_code": "339711627",
"telephone_number": "239-798-8764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4504 LEE BLVD",
"city": "LEHIGH ACRES",
"state": "FL",
"postal_code": "339711627",
"telephone_number": "239-798-8764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EASTMOND",
"first_name": "JULIANNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-11-17",
"last_updated": "2015-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": "FL",
"license": "6906763",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "015293000",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCA",
"identifier": "6906763",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lehigh Acres, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.