Provider Demographics
NPI:1326383852
Name:OPERATION COMMUNITY RESTORE
Entity Type:Organization
Organization Name:OPERATION COMMUNITY RESTORE
Other - Org Name:OCR GROUP HOME & ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LADI
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:MARCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-352-1417
Mailing Address - Street 1:204 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-2809
Mailing Address - Country:US
Mailing Address - Phone:904-352-1417
Mailing Address - Fax:904-352-1416
Practice Address - Street 1:204 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-2809
Practice Address - Country:US
Practice Address - Phone:904-352-1417
Practice Address - Fax:904-352-1416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness