Provider Demographics
NPI:1033257886
Name:THE FANNIE E. TAYLOR HOME FOR THE AGED - CARE CENTER, INC.
Entity Type:Organization
Organization Name:THE FANNIE E. TAYLOR HOME FOR THE AGED - CARE CENTER, INC.
Other - Org Name:TAYLOR CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADCLIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-731-8230
Mailing Address - Street 1:6535 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2250
Mailing Address - Country:US
Mailing Address - Phone:904-731-8230
Mailing Address - Fax:904-731-0669
Practice Address - Street 1:6535 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2250
Practice Address - Country:US
Practice Address - Phone:904-731-8230
Practice Address - Fax:904-731-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1554096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020744600Medicaid
FL020744600Medicaid
FL105821Medicare Oscar/Certification