PEABODY ASSISTED LIVING FACILITY (NPI# 1194174912) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194174912 |
| Entity Type | Organization |
| Organization Name | PEABODY ASSISTED LIVING FACILITY |
| Practice Address |
1309 Peabody Dr E Jacksonville FL 32221-1291 |
| Practice Telephone | 9046952967 |
| Mailing Telephone | 9046952967 |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2016-06-13 |
| Authorized Official Name | ANTONIO MAULION DOCTOR SR. (ADMINISTRATOR) |
| Authorized Official Telephone | 9046952967 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | AL12841 | FL | Nursing & Custodial Care Facilities |
| Street Address |
1309 PEABODY DR E |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32221-1291 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568092534 | Ronetta S Wright | Non-emergency Medical Transport (VAN) | 8450 Perryman Ln N, Jacksonville, FL 32221 | 2020-01-18 |
| 1770128910 | Anointed Hands Support Services LLC | In Home Supportive Care | 11448 Emma Oaks Ln, Jacksonville, FL 32221 | 2019-11-12 |
| 1174173637 | Nichele Blakney | Technician | 10182 Carriage House Court, Jacksonville, FL 32221 | 2019-09-17 |
| 1659892743 | Sebastian Isaza | Dentist | 11043 Crystal Springs Rd Ste 20, Jacksonville, FL 32221 | 2017-06-29 |
| 1518497031 | Valda M Brown | Nurse's Aide | 11201 Lothmore Rd, Jacksonville, FL 32221 | 2017-06-18 |
| 1942603899 | Pain Medicine Physicians of Jacksonville, LLC | Anesthesiology | 10250 Normandy Boulevard, Suite 702, Jacksonville, FL 32221 | 2014-10-07 |
| 1376950501 | Daniel C Marin | Physician Assistant | 1584 Normandy Village Pkwy Ste 32, Jacksonville, FL 32221 | 2014-07-21 |
| 1508001850 | Lilliam Rivera | Registered Nurse | 2236 Brian Lakes Dr. E, Jacksonville, FL 32221 | 2008-12-15 |
| 1992979777 | La Quenda Mosby Pharr | Community Health Worker | 10361 Shelby Creek Rd.s, Jacksonville, FL 32221 | 2008-04-14 |
| 1922167196 | Donald Robert Engels Jr. | Chiropractor | 7661 Knoll Dr N, Jacksonville, FL 32221 | 2006-12-06 |
| Find all providers in zip 32221 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902404668 | Tambolina Services Community Resident Home, Inc | Assisted Living Facility | 6285 Cranberry Ln W, Jacksonville, FL 32244-2559 | 2020-10-15 |
| 1316552284 | Enhanced Universal Care Alf | Assisted Living Facility | 10967 Key Haven Blvd, Jacksonville, FL 32218-4463 | 2020-09-08 |
| 1710527270 | Rosecastle of Jacksonville LLC | Assisted Living Facility | 8929 R G Skinner Pkwy, Jacksonville, FL 32256-9724 | 2020-01-13 |
| 1891353777 | V & K Horizons | Assisted Living Facility | 7019 Mark St, Jacksonville, FL 32210-4889 | 2019-06-05 |
| 1144784638 | Carole Stallworth | Assisted Living Facility | 5116 Mcmanus Dr, Jacksonville, FL 32210-6353 | 2019-01-29 |
| 1467921569 | Heart To Heart LLC | Assisted Living Facility | 9378 Arlignton Expressway, Ste 218, Jacksonville, FL 32225 | 2018-11-19 |
| 1073090437 | Lashonda Oglesby | Assisted Living Facility | 6313 Arlington Rd, Jacksonville, FL 32211-5423 | 2018-07-27 |
| 1831697218 | Cortney Irene Matthews | Assisted Living Facility | 3109 Gilmore St, Jacksonville, FL 32205-5516 | 2018-01-31 |
| 1093222515 | Anthem Lakes | Assisted Living Facility | 905 Assisi Ln, Jacksonville, FL 32233-2972 | 2018-01-05 |
| 1831608975 | Silver Shores Living, Inc | Assisted Living Facility | 2317 Gilmore St, Jacksonville, FL 32204-3119 | 2017-09-20 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32221 |
Please comment or provide details below to improve the information on PEABODY ASSISTED LIVING FACILITY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.