| NPI | 1669479192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN ALAN GOETZ Executive Director 904-260-1818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: FL SNF1476096) |
| Additional Taxonomies | 251E00000X Home Health (Licence: FL HHA299991334) |
| 313M00000X Nursing Facility/Intermediate Care Facility (Licence: FL SNF1476096) | |
| 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies (Licence: FL snf1476096) | |
| 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: FL snf1476096) | |
| 333600000X Pharmacy (Licence: FL PH2050) | |
| 333600000X Pharmacy (Licence: FL PH13972) | |
| 3336L0003X Pharmacy, Long Term Care Pharmacy | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2022-09-23 |