Ms Jacksonville SH, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL11689 Issued in FL

Legal business name

MS JACKSONVILLE SH, LLC

Doing business as

Sunrise of Jacksonville

Practice address

4870 Belfort Rd
Jacksonville, FL 32256-6004

Phone

(904) 332-0774

Fax

(904) 332-0775

NPI assigned

Nov 12, 2014

Organization subpart

No

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

Authorized official

Name

Karen O'Hara

Title

Executive Director

Phone

(904) 332-0774

Specialties & licenses 1

Addresses

Other names 1

• Sunrise of Jacksonville Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1415750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415750400000",
    "number": "1750787131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4870 BELFORT RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566004",
            "telephone_number": "904-332-0774",
            "fax_number": "904-332-0775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4870 BELFORT RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566004",
            "telephone_number": "904-332-0774",
            "fax_number": "904-332-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MS JACKSONVILLE SH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-12",
        "last_updated": "2014-11-12",
        "status": "A",
        "authorized_official_last_name": "O'HARA",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "904-332-0774"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunrise of Jacksonville",
            "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 Nov 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.