PETERSON ASSISTED LIVING FACILITY (NPI# 1447697628) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447697628 |
| Entity Type | Organization |
| Organization Name | PETERSON ASSISTED LIVING FACILITY |
| Practice Address |
1622 Silver St Jacksonville FL 32206-4446 |
| Practice Telephone | 9043563022 |
| Practice Fax Number | 9043509165 |
| Mailing Telephone | 9043563022 |
| Mailing Fax Number | 9043509165 |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2013-05-29 |
| Authorized Official Name | MS. LAVERNE JACKSON (DIRECTOR OF OPERATION) |
| Authorized Official Telephone | 9043563922 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | AL8638 | FL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 140750300 | 05 |
| Street Address |
1622 SILVER ST |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32206-4446 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790275543 | Marvin Victor Sindel IIi | Nurse Practitioner | 1241 E 8th St, Jacksonville, FL 32206 | 2018-05-17 |
| 1982126553 | Marcia Camille Holloway | In Home Supportive Care | 647 East 31th Street, Jacksonville, FL 32206 | 2017-07-14 |
| 1407302656 | Tahnita Fleming | Day Training, Developmentally Disabled Services | 1309 Van Buren Street, Jacksonville, FL 32206 | 2016-08-28 |
| 1912202136 | Bishop Home Care, Inc | Clinic/Center | 1627 E 8th Street, Jacksonville, FL 32206 | 2011-01-19 |
| 1407183965 | Richard Adam Crosby | Chiropractor | 4211 North Pearl St., Jacksonville, FL 32206 | 2009-11-04 |
| 1346494903 | Delvenia Renee Mitchell | Specialist | 4515 N Pearl St Apt 2, Jacksonville, FL 32206 | 2008-11-10 |
| 1962662775 | Curtis Michael Bryant | Radiology | 2015 Jefferson Street, University of Florida Proton Institute, Jacksonville, FL 32206 | 2008-06-15 |
| 1932253879 | Gale Marie Cohen-weiss | Social Worker | Veterans Health System, Jacksonville Outpatient Clinic, 1833 Boulevard, Jacksonville, FL 32206 | 2007-01-22 |
| 1396817557 | Bella Caimol Ejercito | Internal Medicine | 4608 Norwood Ave, Jacksonville, FL 32206 | 2006-11-14 |
| 1962584433 | Jessica Ivette Warthen | Pharmacist | 1833 Boluevard, Department of Veterans Affairs; Mental Health Clinic, Jacksonville, FL 32206 | 2006-10-20 |
| Find all providers in zip 32206 | ||||
| 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 | 32206 |
Please comment or provide details below to improve the information on PETERSON 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.