Carlene Spencer Adult Family Care Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

6905980 Issued in FL

Legal business name

CARLENE SPENCER ADULT FAMILY CARE HOME

Practice address

5120 Foxboro Rd
Jacksonville, FL 32208-1027

Phone

(904) 766-0307

NPI assigned

Mar 17, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Carlene Spencer

Title

Owner/Caretaker

Phone

(904) 766-0307

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1237248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237420800000",
    "number": "1972744209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5120 FOXBORO RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322081027",
            "telephone_number": "904-766-0307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5120 FOXBORO RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322081027",
            "telephone_number": "904-766-0307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLENE SPENCER ADULT FAMILY CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-17",
        "last_updated": "2009-03-19",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "CARLENE",
        "authorized_official_title_or_position": "OWNER/CARETAKER",
        "authorized_official_telephone_number": "904-766-0307",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "FL",
            "license": "6905980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6931081 98",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Adult Care Home Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2009; 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.