Innovative Health Care Properties D B a Summer Brook Health Care Cente

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1132096 Issued in FL

Legal business name

INNOVATIVE HEALTH CARE PROPERTIES D B A SUMMER BROOK HEALTH CARE CENTE

Doing business as

Innovative Health Care Properties

Practice address

5377 Moncrief Rd
Jacksonville, FL 32209-3159

Phone

(904) 768-1506

Fax

(904) 766-1772

NPI assigned

Oct 26, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Dewayne K Harvey

Title

Administrator

Phone

(904) 768-1506

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Innovative Health Care Properties Doing business as

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972593390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5377 MONCRIEF RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322093159",
            "telephone_number": "904-768-1506",
            "fax_number": "904-766-1772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5377 MONCRIEF RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322093159",
            "telephone_number": "904-768-1506",
            "fax_number": "904-766-1772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE HEALTH CARE PROPERTIES D B A SUMMER BROOK HEALTH CARE CENTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARVEY",
        "authorized_official_first_name": "DEWAYNE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-768-1506",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1132096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA PROVIDER NUMBER",
            "identifier": "M52",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovative Health Care Properties",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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.