3455 San Pablo Rd S Tenant LLC
Assisted Living Facility in Jacksonville, FL. Organization (NPI-2).
NPI number1205664349
StatusActive
Last updated in NPPESJul 22, 2024
Details
- NPI
- 1205664349
- Entity type
- Organization (NPI-2)
- Legal business name
- 3455 San Pablo Rd S Tenant LLC
- Organization subpart
- No
- Enumeration date
- Jul 22, 2024
- Certification date
- Jun 28, 2024
- Last updated
- Jul 22, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 310400000X | Assisted Living Facility | – | – | Yes |
| 311500000X | Alzheimer Center (Dementia Center) | – | – |
Other names
- The Gables Of Jacksonville (Doing Business As)
Practice location
3455 San Pablo Rd SJacksonville, FL 32224-3803
Phone 904-821-8030
Mailing address
8415 E 21st St N Ste 100Wichita, KS 67206-2959
Phone 316-616-6288
Authorized official
Sharon Makowsky
Authorized Representative
4192472800
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