San Juan Retirement Home

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

License

9587 Issued in FL

Legal business name

SAN JUAN RETIREMENT HOME

Practice address

6561 San Juan Ave
Jacksonville, FL 32210-2857

Phone

(904) 695-9605

Fax

(904) 693-1973

NPI assigned

Jan 11, 2013

Organization subpart

No

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

Authorized official

Name

Elvira Demdam, R.N.

Title

Alf Administrator

Phone

(904) 695-9605

Specialties & licenses 1

Addresses

Tax ID family

San Juan Retirement Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• San Juan Retirement Home

  • Alzheimer Center (Dementia Center)
  • Jacksonville, FL
  • NPI 1053656199
  NPD tax ID

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

{
    "created_epoch": "1357862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357862400000",
    "number": "1891032868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6561 SAN JUAN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322102857",
            "telephone_number": "904-695-9605",
            "fax_number": "904-693-1973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6561 SAN JUAN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322102857",
            "telephone_number": "904-695-9605",
            "fax_number": "904-693-1973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN RETIREMENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-11",
        "last_updated": "2013-01-11",
        "status": "A",
        "authorized_official_last_name": "DEMDAM",
        "authorized_official_first_name": "ELVIRA",
        "authorized_official_title_or_position": "ALF ADMINISTRATOR",
        "authorized_official_telephone_number": "904-695-9605",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "FL",
            "license": "9587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• San Jose Imaging Center LLC
• San Jose Therapy Services LLC
• San Juan Dentistry PA
• San Juan Diagnostics LLC
• San Juan Retirement Home
• San Marco Chiropractic and Wellness Center
• San Marco Dentistry
• Tiana San Nicolas Collins
• Danielle Joi Sanchack, PSY.D
• Kristian E Sanchack, MD

• Assisted Living Facility (Behavioral Disturbances) in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Assisted Living Facility (Behavioral Disturbances) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2013; 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.