FLORIDA DEPARTMENT OF VETERANS AFFAIRS (NPI# 1629060272) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1629060272 |
Entity Type | Organization |
Organization Name | FLORIDA DEPARTMENT OF VETERANS AFFAIRS |
Other Organization Name | DOUGLAS JACOBSON STATE VETERANS NURSING HOME |
Practice Address |
21281 Grayton Ter Port Charlotte FL 33954-3109 |
Practice Telephone | 9416130919 |
Practice Fax Number | 9416130935 |
Mailing Telephone | 9416130919 |
Mailing Fax Number | 9416130935 |
Enumeration Date | 2005-08-19 |
Last Update Date | 2020-08-22 |
Authorized Official Name | MR. WILLIAM G PUCKETT (PROGRAM DIRECTOR) |
Authorized Official Telephone | 7275183202 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
X | 311500000X | Alzheimer Center (Dementia Center) | FL | Nursing & Custodial Care Facilities | |
X | 314000000X | Skilled Nursing Facility | FL | Nursing & Custodial Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
FL | BCBS | M4J | 01 |
Other Name | Type Code |
---|---|
Douglas Jacobson State Veterans Nursing Home | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912215583 | Florida Department of Veterans Affairs | Skilled Nursing Facility | 4650 State Road 16, Saint Augustine, FL 32092-0600 | 2010-09-17 |
1174515654 | Florida Department of Veterans Affairs | Skilled Nursing Facility | 1920 Mason Ave, Daytona Beach, FL 32117-5103 | 2005-08-19 |
1316939804 | Florida Department of Veterans Affairs | Skilled Nursing Facility | 6919 Parkway Blvd, Land O Lakes, FL 34639-2909 | 2005-08-19 |
1962494518 | Florida Department of Veterans Affairs | Assisted Living Facility | 751 Se Sycamore Ter, Lake City, FL 32025-6216 | 2005-08-19 |
1518959667 | Florida Department of Veterans Affairs | Alzheimer Center (Dementia Center) | 4419 Tram Rd, Panama City, FL 32404-2559 | 2005-08-16 |
1417949579 | Florida Department of Veterans Affairs | Alzheimer Center (Dementia Center) | 8401 W Cypress Dr, Pembroke Pines, FL 33025-4540 | 2005-08-16 |
Street Address |
21281 GRAYTON TER |
City | PORT CHARLOTTE |
State | FL |
Zip Code | 33954-3109 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1588219760 | Travis Darrow | Occupational Therapist | 21281 Grayton Ter, Port Charlotte, FL 33954-3109 | 2019-08-05 |
1841703956 | Anthony B Dozier II | Physical Therapist | 21281 Grayton Ter, Port Charlotte, FL 33954-3109 | 2017-11-10 |
1336521673 | Callman Internal Medicine | Internal Medicine | 21281 Grayton Ter, D Jacobson Va Nh, Port Charlotte, FL 33954-3109 | 2015-06-23 |
1750788287 | Vickie Shuffitt | Physical Therapist | 21281 Grayton Ter, Douglas T Jacobson Veterans Home, Port Charlotte, FL 33954-3109 | 2014-11-26 |
1932366689 | Kristen Marie Bowman | Physical Therapist | 21281 Grayton Ter, Port Charlotte, FL 33954-3109 | 2008-05-20 |
1336238468 | Marie May Beadle | Pharmacist | 21281 Grayton Ter, Port Charlotte, FL 33954-3109 | 2006-10-12 |
1922060904 | Linda Barbara Lee-bardowski | Registered Nurse | 21281 Grayton Ter, Port Charlotte, FL 33954-3109 | 2006-04-05 |
1023005741 | Mary Virginia Caputi | Pharmacist | 21281 Grayton Ter, Douglas T. Jacobson State Veterans Nursing Home, Port Charlotte, FL 33954-3109 | 2005-09-29 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1043740665 | Criselda Veronica Romero | Home Health Aide | 24009 Madaca Lane, Apt 104, Port Charlotte, FL 33954 | 2017-06-15 |
1942469234 | Johanny Vizcarrondo Colon | Physical Therapist | 24011 Madaca Lane # 108, Port Charlotte, FL 33954 | 2008-06-03 |
1467638163 | Qrs LLC | Clinic/Center | 17218 Toledo Blade Blvd., Unit 7, Port Charlotte, FL 33954 | 2008-01-14 |
1023199155 | Visionworks Inc | Eyewear Supplier (Equipment, not the service) | 18500 Veterans Boulevard, Unit 4, Port Charlotte, FL 33954 | 2006-10-17 |
1174577290 | Karen Kalbfeld | Nurse Anesthetist, Certified Registered | 327 Kindred Blvd, Port Charlotte, FL 33954 | 2006-05-22 |
1518425081 | Annette Simmons | Custodial Care Facility | 1292 Dorchester St, Port Charlotte, FL 33954 | 2019-03-04 |
1942319744 | Lifeline Health Care of Southwest Florida, Inc. | Home Health | 630a Woodbury Dr, Port Charlotte, FL 33954-1000 | 2006-08-29 |
1154617553 | Anthony Richard La Forgia | Counselor | 630a Woodbury Dr, Port Charlotte, FL 33954-1000 | 2011-06-23 |
1780227199 | Sergio Pedro Castro | Behavioral Analyst | 18245 Paulson Dr Ste 113, Port Charlotte, FL 33954-1019 | 2019-10-18 |
1295201846 | Grissel Alfonso Gonzalez | Behavior Technician | 18245 Paulson Dr Ste 130, Port Charlotte, FL 33954-1019 | 2018-10-22 |
Find all providers in zip 33954 |
Taxonomy Code | 311500000X |
Grouping | Nursing & Custodial Care Facilities |
Classification | Alzheimer Center (Dementia Center) |
A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer’s Disease or their related diseases. Six elements of the facility/unit set it apart from other (the rest of the) facilities(y): Admission of residents with dementia (including those with Alzheimer's disease); Staff who are specially selected, trained, and supervised; Activities that are specifically designed for the cognitively impaired; A marketing of a special care unit in brochures; A high level of family involvement; and A physical environment designed to keep residents safe and segregated from other populations. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1114527744 | Somh Boca Raton Operating, LLC | Alzheimer Center (Dementia Center) | 21865 Ponderosa Dr, Boca Raton, FL 33428-6215 | 2020-11-01 |
1417556978 | Mh Gentry Park Al Operating, LLC | Alzheimer Center (Dementia Center) | 3201 Center Pointe Dr, Orlando, FL 32825-6323 | 2020-10-25 |
1144876327 | Immaculate Adult Day Care LLC | Alzheimer Center (Dementia Center) | 234 Willard St Ste A, Cocoa, FL 32922-7984 | 2019-08-14 |
1982172995 | Pacifica Augustine Road LLC | Alzheimer Center (Dementia Center) | 10660 Old Augustine Road, Jacksonville, FL 32257 | 2018-11-07 |
1689152910 | American Eagle Leesburg Mc LLC | Alzheimer Center (Dementia Center) | 710 S Lake St, Leesburg, FL 34748-7327 | 2018-07-30 |
1518445857 | American Eagle Venice Island LLC | Alzheimer Center (Dementia Center) | 1200 Avenida Del Circo, Venice, FL 34285 | 2018-07-30 |
1780160192 | Ganesh Healthcare of Jax LLC | Alzheimer Center (Dementia Center) | 644 Cesery Blvd Ste 150, Jacksonville, FL 32211 | 2018-07-18 |
1861917171 | Memory Lane Cottage At Oviedo, LLC | Alzheimer Center (Dementia Center) | 450 Oviedo Blvd, Oviedo, FL 32765-3508 | 2017-08-08 |
1891219119 | Waveney Gittens-williams | Alzheimer Center (Dementia Center) | 3706 W. Idle Wild Cir #203, Tampa, FL 33614 | 2017-07-28 |
1831640697 | Senior Living Iv Sun City, LLC | Alzheimer Center (Dementia Center) | 1320 33rd St Se, Ruskin, FL 33573-4904 | 2016-10-17 |
Find all providers with the same taxonomy |
City | PORT CHARLOTTE |
Zip Code | 33954 |
Please comment or provide details below to improve the information on FLORIDA DEPARTMENT OF VETERANS AFFAIRS.
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.