Jacksonville Opco, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

JACKSONVILLE OPCO, LLC

Doing business as

Angelina House

Practice address

211 Philip St
Jacksonville, TX 75766-5518

Phone

(903) 589-1105

NPI assigned

Feb 14, 2023

Last updated

Feb 14, 2023By 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

Mr. Avi Elias

Title

President

Phone

(727) 639-1419

Specialties & licenses 1

Addresses

Other names 1

• Angelina House Doing business as

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

{
    "created_epoch": "1676332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676332800000",
    "number": "1821795428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2568",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286032568",
            "telephone_number": "828-270-0651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 PHILIP ST",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757665518",
            "telephone_number": "903-589-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-14",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A",
        "authorized_official_last_name": "ELIAS",
        "authorized_official_first_name": "AVI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-639-1419",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Angelina House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Jacksonville, TX
• Providers in Jacksonville, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; 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.