Active NPI
Justina Threadgill
- Assisted Living Facility
- Daytona Beach, FL
National Provider Identifier
1942624366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- 10287
- Practice address
- 1312 Mardrake Rd
Daytona Beach, FL 32114-5940 - Phone
- (386) 257-2162
- NPI assigned
- Feb 5, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 10287 | FL | Primary |
Addresses
Primary practice location
1312 Mardrake Rd
Daytona Beach, FL 32114-5940
Mailing address
1312 Mardrake Rd
Daytona Beach, FL 32114-5940
Phone (386) 257-2162
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10287 | FL | MD | Assisted Living Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blossoms Assisted Living 1, LLC | Assisted Living Facility | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Assisted Living Facility
- Davenport, FL
- NPI 1588051528
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391558400000",
"number": "1942624366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1312 MARDRAKE RD",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321145940",
"telephone_number": "386-257-2162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1312 MARDRAKE RD",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321145940",
"telephone_number": "386-257-2162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THREADGILL",
"first_name": "JUSTINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-05",
"last_updated": "2014-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "FL",
"license": "10287",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Daytona Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.