Florida Southern Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

FLORIDA SOUTHERN ASSISTED LIVING LLC

Doing business as

Ingleside Retirement Home

Practice address

1433 Ingleside Ave
Jacksonville, FL 32205-7712

Phone

(843) 571-5399

Fax

(843) 571-5659

NPI assigned

Mar 19, 2013

Last updated

Mar 19, 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

Stephanie WoodruffNPI 1811903818

Title

Ceo

Phone

(843) 571-5366

Specialties & licenses 1

Addresses

Other names 1

• Ingleside Retirement Home Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephanie Bradshaw Woodruff, DC

  • Chiropractor
  • Charleston, SC
  • NPI 1811903818
  Authorized official Same address or phone

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

{
    "created_epoch": "1363651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363651200000",
    "number": "1689916546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 PHYSICIANS DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145746",
            "telephone_number": "843-571-5366",
            "fax_number": "843-571-5659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 INGLESIDE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322057712",
            "telephone_number": "843-571-5399",
            "fax_number": "843-571-5659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA SOUTHERN ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-19",
        "last_updated": "2013-03-19",
        "status": "A",
        "authorized_official_last_name": "WOODRUFF",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-571-5366"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ingleside Retirement Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Mar 19, 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.