Jacksonville Extended Care, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

130471028 Issued in FL

Legal business name

JACKSONVILLE EXTENDED CARE, LLC

Doing business as

Southpoint Terrace

Practice address

4325 Southpoint Blvd
Jacksonville, FL 32216-6166

Phone

(904) 245-7620

Fax

(904) 281-9956

NPI assigned

Mar 17, 2006

Last updated

Apr 25, 2012By 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

Donna J Marsh

Title

Bookkeeper

Phone

(380) 255-1054

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southpoint Terrace Doing business as

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335312000000",
    "number": "1700855939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4325 SOUTHPOINT BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166166",
            "telephone_number": "904-245-7620",
            "fax_number": "904-281-9956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4325 SOUTHPOINT BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166166",
            "telephone_number": "904-245-7620",
            "fax_number": "904-281-9956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE EXTENDED CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-17",
        "last_updated": "2012-04-25",
        "status": "A",
        "authorized_official_last_name": "MARSH",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "BOOKKEEPER",
        "authorized_official_telephone_number": "380-255-1054"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "130471028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026628100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southpoint Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 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.