Jba SVCS Inc D/B/a Immaculate House at Countryside

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL 11233 Issued in FL

Legal business name

JBA SVCS INC D/B/A IMMACULATE HOUSE AT COUNTRYSIDE

Practice address

2542 Countryside Pines Dr
Clearwater, FL 33761-4921

Phone

(727) 934-4310

Fax

(727) 943-2075

NPI assigned

May 10, 2008

Organization subpart

Yes

Parent organization

JBA SVCS INC D/B/A FOREST HILLS HOME AT PALM HARBORAs reported in NPPES

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

Authorized official

Name

Ms. Joanne Bock-Ackerman, AHCA ALF ADMIN.

Title

Alf Administrator

Phone

(727) 934-4310

Specialties & licenses 1

Addresses

Other names 1

• Forest Hills Home at Palm Harbor Doing business as

Tax ID family

Jba SVCS Inc Dba Forest Hills Home2 organizations share this tax ID, including this one

Part of

Jba SVCS Inc Dba Forest Hills Home

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jba SVCS Inc D/B/a Forest Hills Home

  • Assisted Living Facility
  • Palm Harbor, FL
  • NPI 1659567600
  NPD tax ID

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

{
    "created_epoch": "1210377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210377600000",
    "number": "1710154604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3823 PENDLEBURY DR",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346852670",
            "telephone_number": "727-934-4310",
            "fax_number": "727-943-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2542 COUNTRYSIDE PINES DR",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337614921",
            "telephone_number": "727-934-4310",
            "fax_number": "727-943-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JBA SVCS INC D/B/A IMMACULATE HOUSE AT COUNTRYSIDE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JBA SVCS INC D/B/A FOREST HILLS HOME AT PALM HARBOR",
        "enumeration_date": "2008-05-10",
        "last_updated": "2008-05-10",
        "status": "A",
        "authorized_official_last_name": "BOCK-ACKERMAN",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_title_or_position": "ALF ADMINISTRATOR",
        "authorized_official_telephone_number": "727-934-4310",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "AHCA ALF ADMIN."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL 11233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forest Hills Home at Palm Harbor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jay E Carpenter MD PA
• Jay Rosenfeld OD PA
• Jayam K. Iyer M.D., P.a
• Jayasri Duggirala MD PA
• Jayco Anesthesia Service LLC
• JCS Medical Associates PLC
• JDG Circle Inpatient Services LLC
• Nisrene Jebara, DNP
• Orinthal Jefferson, MASTERS
• Rashad M Jefferson, D.D.S.

• Assisted Living Facility in Clearwater, FL
• Providers in Clearwater, 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 May 10, 2008; 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.