NORTH FLORIDA SENIOR LIVING LLC (NPI# 1730711219) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730711219 |
| Entity Type | Organization |
| Organization Name | NORTH FLORIDA SENIOR LIVING LLC |
| Practice Address |
541103 Lem Turner Rd Callahan FL 32011-8546 |
| Mailing Address |
614 Bowles Ct Neptune Beach FL 32266-3602 |
| Practice Telephone | 9046356081 |
| Mailing Telephone | 9046356081 |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2020-02-12 |
| Authorized Official Name | MR. EVGENY CHERNYAK (VICE PRESIDENT) |
| Authorized Official Telephone | 9046356081 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0630X |
Assisted Living Facility Specialization: Assisted Living, Behavioral Disturbances |
Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| North Florida Senior Living LLC | Former Legal Business Name - Organization |
| Street Address |
541103 LEM TURNER RD |
| City | CALLAHAN |
| State | FL |
| Zip Code | 32011-8546 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508327875 | Lathern Barnard Jones | Respiratory Therapist, Registered | 45772 Jones Way, Callahan, FL 32011 | 2019-03-28 |
| 1245799907 | Allan Harrison | Homemaker | 543514 Us Highway 1, Callahan, FL 32011 | 2019-03-13 |
| 1801360920 | Taylor Marie Catrett | Nurse Practitioner | 449621 Us Highway 201, Suite 201, Callahan, FL 32011 | 2019-01-11 |
| 1528369063 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 542356 Us Highway 1, Callahan, FL 32011 | 2010-11-16 |
| 1033310313 | James Roger Harrison | Dentist | 45390 Green Ave., Callahan, FL 32011 | 2007-05-31 |
| 1700993383 | William David Titus | Dentist | 542182 U. S. Highway 1, Callahan, FL 32011 | 2006-08-23 |
| 1083623953 | Bettye Ann Spillers | Registered Nurse | 45377 Mickler Street, Callahan, FL 32011 | 2006-08-07 |
| 1285691691 | Daniel Robert Weaver | Chiropractor | 542184 S Kings Rd, Space 3b, Callahan, FL 32011 | 2006-04-28 |
| 1780659169 | Cara A Lapkowicz | Podiatrist | 542067 Us Hwy 1, Callahan, FL 32011 | 2006-02-21 |
| 1245716836 | Haylie Whittenburg | Nurse Practitioner | 542325 Us Highway 1, Callahan, FL 32011 | 2018-07-17 |
| Find all providers in zip 32011 | ||||
| Taxonomy Code | 3104A0630X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Behavioral Disturbances |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366040354 | Jaime E Hatch | Assisted Living Facility | 86374 Peeples Rd, Yulee, FL 32097-3387 | 2020-10-13 |
| 1144860206 | Iconnect Jax | Assisted Living Facility | 4372 Southside Blvd Ste 203, Jacksonville, FL 32216-8503 | 2020-01-07 |
| 1013495175 | Sunshine Assisted Living Home Care Facility. | Assisted Living Facility | 1422 Se 23rd Ter., Crape Coral, FL 33990 | 2018-08-01 |
| 1790276905 | Villa Rosa Iv, Inc. | Assisted Living Facility | 3051 E. 4 Avenue, Hialeah, FL 33013 | 2018-05-23 |
| 1679062814 | Interdisciplinary Healthcare Services LLC | Assisted Living Facility | 12751 Sw 226 Street, Miami, FL 33170 | 2018-05-03 |
| 1104368240 | Jermaine Jordan | Assisted Living Facility | 1210 Retreat View Cir, Sanford, FL 32771-7276 | 2016-11-07 |
| 1346617412 | Louise Irving | Assisted Living Facility | 4561 Sw 36th St, West Park, FL 33023-5511 | 2015-08-25 |
| 1821473000 | A-1 Medical and Behavioral Management Svc | Assisted Living Facility | 2822 54th Ave S, # 215, St Petersburg, FL 33712-4610 | 2015-07-29 |
| 1730574906 | Jordico LLC | Assisted Living Facility | 4417 13th Street, Suite 142, Saint Cloud, FL 34769 | 2015-04-03 |
| 1598164576 | Daryn Hall | Assisted Living Facility | 10535 Lem Turner Rd Apt 715, Jacksonville, FL 32218-9113 | 2014-08-15 |
| Find all providers with the same taxonomy | ||||
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| 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.