Provider Demographics
NPI:1033745518
Name:INGLESIDE ALF HOME LLC
Entity Type:Organization
Organization Name:INGLESIDE ALF HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERA
Authorized Official - Middle Name:JUNATAS
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-686-0102
Mailing Address - Street 1:1433 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-7712
Mailing Address - Country:US
Mailing Address - Phone:904-686-0102
Mailing Address - Fax:888-374-8792
Practice Address - Street 1:1433 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-7712
Practice Address - Country:US
Practice Address - Phone:904-686-0102
Practice Address - Fax:888-374-8792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility