Jacobsladder Family

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL11180 Issued in FL

Legal business name

JACOBSLADDER FAMILY

Practice address

946 Brunswick LN
Rockledge, FL 32955-4070

Phone

(321) 223-3967

NPI assigned

May 14, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Karolena Marie Declercq, R.N.

Title

Administrator

Phone

(321) 223-3967

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1336953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336953600000",
    "number": "1992064729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "946 BRUNSWICK LN",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554070",
            "telephone_number": "321-223-3967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "946 BRUNSWICK LN",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554070",
            "telephone_number": "321-223-3967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOBSLADDER FAMILY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-14",
        "last_updated": "2012-05-14",
        "status": "A",
        "authorized_official_last_name": "DECLERCQ",
        "authorized_official_first_name": "KAROLENA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "321-223-3967",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AGENCY FOR HEALTH CARE ADMINISTRATION",
            "identifier": "AL11180",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J&L Bowman Corp
• Joey Jachec, MS, LMHC, NCC
• Quantearia Jackson
• Tina Jackson
• Jacob'S Ladder III Family Alf
• Donna Jacoby, LCSW
• Jennie Jacques
• Lauren Scarborough Jadeja, D.M.D.
• Katie Jaehne
• Rita Jain, M.D.

• Assisted Living Facility in Rockledge, FL
• Providers in Rockledge, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2012; 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.