St Johns County Welfare Federation

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1489096 Issued in FL

Legal business name

ST JOHNS COUNTY WELFARE FEDERATION

Doing business as

Samantha Wilson Care Center

Practice address

161 Marine St
St Augustine, FL 32084-5154

Phone

(904) 829-3475

Fax

(904) 808-9908

NPI assigned

Jan 26, 2007

Organization subpart

No

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

Authorized official

Name

Larry Lake, PHD, NHA

Title

Administrator

Phone

(904) 824-2501

Specialties & licenses 1

Addresses

Other names 1

• Samantha Wilson Care Center Doing business as

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861548562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 MARINE ST",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320845154",
            "telephone_number": "904-829-3475",
            "fax_number": "904-808-9908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 MARINE ST",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320845154",
            "telephone_number": "904-829-3475",
            "fax_number": "904-808-9908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHNS COUNTY WELFARE FEDERATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-824-2501",
        "authorized_official_credential": "PHD, NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1489096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samantha Wilson Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St Johns County Board of County Commissioners
• St Johns County Board of County Commissioners
• St Johns County Board of County Commissioners
• St Johns County Board of County Commissioners
• St Johns County Welfare Federation (Buckingham Smith Assisted Living Facility)
• St Johns County Welfare Federation (Bayview Home Health Of St Augustine)
• St Johns Eye Associates PA
• St Johns Eye Associates PA
• St Johns Family Chiropractic Inc
• St Johns First Assistant

• Skilled Nursing Facility in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.