Fremont Assisted Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12549 Issued in FL

Legal business name

FREMONT ASSISTED LIVING

Practice address

2200 Bayview Rd
Jacksonville, FL 32210-4213

Phone

(904) 800-2653

Fax

(904) 800-2656

NPI assigned

Oct 13, 2014

Organization subpart

No

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

Authorized official

Name

Angelus Gallo Pancho

Title

Manager

Phone

(904) 800-2653

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1413158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413158400000",
    "number": "1831593383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 BAYVIEW RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322104213",
            "telephone_number": "904-800-2653",
            "fax_number": "904-800-2656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 BAYVIEW RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322104213",
            "telephone_number": "904-800-2653",
            "fax_number": "904-800-2656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREMONT ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-13",
        "last_updated": "2014-10-13",
        "status": "A",
        "authorized_official_last_name": "PANCHO",
        "authorized_official_first_name": "ANGELUS",
        "authorized_official_middle_name": "GALLO",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "904-800-2653"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Jacksonville, FL
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• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; 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.