NPIMap

Organization Active NPI

Summerville at St. Augustine, LLC

Doing business as Brookdale St. Augustine

  • Assisted Living Facility
  • St Augustine, FL
National Provider Identifier
1902132749
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL9908 Issued in FL
Legal business name
SUMMERVILLE AT ST. AUGUSTINE, LLC
Doing business as
Brookdale St. Augustine
Practice address
150 Mariner Health Way
St Augustine, FL 32086-3215
Phone
(904) 794-9988
NPI assigned
Oct 29, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Authorized official

Name
Anna Munoz
Title
Assistant Secretary
Phone
(414) 918-5443

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL9908 FL Primary

Addresses

Primary practice location

150 Mariner Health Way
St Augustine, FL 32086-3215

Mailing address

150 Mariner Health Way
St Augustine, FL 32086-3215
Phone (904) 794-9988

Other identifiers 1

IdentifierTypeStateIssuer
0124330-00MedicaidFL

Other names 1

  • Brookdale St. Augustine Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1080868Brookdale St Augustine150 Mariner Health Way, Saint Augustine, FL 32086Certificate of waiverMar 3, 2028

National Provider Directory

National Provider Directory
Tax ID family
Summerville at St Augustine LLC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

NPI Registry JSON

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

{
    "created_epoch": "1256774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727654400000",
    "number": "1902132749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MARINER HEALTH WAY",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320863215",
            "telephone_number": "904-794-9988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MARINER HEALTH WAY",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320863215",
            "telephone_number": "904-794-9988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERVILLE AT ST. AUGUSTINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-29",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "MUNOZ",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "414-918-5443"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL9908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0124330-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale St. Augustine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.