St. Philomena Assisted Living Facilities, LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

AL12632 Issued in FL

Legal business name

ST. PHILOMENA ASSISTED LIVING FACILITIES, LLC

Practice address

3943 Eldridge Ave
Orange Park, FL 32073-2128

Phone

(904) 470-9965

NPI assigned

Mar 11, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Phyllis Lashley RodgersNPI 1235521956

Title

Owner

Phone

(904) 470-9965

Specialties & licenses 1

Addresses

Other names 1

• St. Philomena Assisted Living Other name

Practitioners 1

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

• Phyllis Lashley Rodgers

  • Nurse's Aide
  • Jacksonville, FL
  • NPI 1235521956

  Assisted Living, Mental Illness

  NPD (past) Authorized official

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

{
    "created_epoch": "1426032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426032000000",
    "number": "1679966873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5520 KILKEE CT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322446259",
            "telephone_number": "904-470-9965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3943 ELDRIDGE AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320732128",
            "telephone_number": "904-470-9965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. PHILOMENA ASSISTED LIVING FACILITIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-11",
        "last_updated": "2015-03-11",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "LASHLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-470-9965",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "AL12632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Philomena Assisted Living",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Assisted Living Facility (Mental Illness) in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Assisted Living Facility (Mental Illness) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.

Verify at the official NPI Registry.