Provider Demographics
NPI:1265678080
Name:LIFE CARE PONTE VEDRA
Entity Type:Organization
Organization Name:LIFE CARE PONTE VEDRA
Other - Org Name:VICAR'S LANDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-273-1701
Mailing Address - Street 1:1000 VICARS LANDING WAY
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3151
Mailing Address - Country:US
Mailing Address - Phone:904-273-1701
Mailing Address - Fax:904-285-1384
Practice Address - Street 1:1003 YORK RD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3116
Practice Address - Country:US
Practice Address - Phone:904-273-1718
Practice Address - Fax:904-273-9573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation