Heartland - South Jacksonville of Jacksonville FL LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1310096 Issued in FL

Legal business name

HEARTLAND - SOUTH JACKSONVILLE OF JACKSONVILLE FL LLC

Doing business as

Heartland Health Care Center of South Jacksonville

Practice address

3648 University Blvd S
Jacksonville, FL 32216-4208

Phone

(904) 733-7440

Fax

(904) 448-9425

NPI assigned

May 28, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Martin D Allen

Title

Director

Phone

(419) 252-5734

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Heartland Health Care Center of South Jacksonville Doing business as

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497571200000",
    "number": "1790732287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436042615",
            "telephone_number": "419-252-5500",
            "fax_number": "877-385-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3648 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164208",
            "telephone_number": "904-733-7440",
            "fax_number": "904-448-9425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND - SOUTH JACKSONVILLE OF JACKSONVILLE FL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2017-06-16",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "419-252-5734",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1310096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "032528700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Health Care Center of South Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Jacksonville, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2017; 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.