Provider Demographics
NPI:1114326410
Name:NOBLE HOUSE RETIREMENT OF JACKSONVILLE
Entity Type:Organization
Organization Name:NOBLE HOUSE RETIREMENT OF JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LALAINE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CATE
Authorized Official - Suffix:
Authorized Official - Credentials:GRADUATE
Authorized Official - Phone:904-695-9605
Mailing Address - Street 1:6561 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2857
Mailing Address - Country:US
Mailing Address - Phone:904-695-9605
Mailing Address - Fax:904-693-1973
Practice Address - Street 1:6561 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2857
Practice Address - Country:US
Practice Address - Phone:904-695-9605
Practice Address - Fax:904-693-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9587310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility