Provider Demographics
NPI:1417044579
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:DIRECTOR OF NURSING SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS, DON
Authorized Official - Phone:904-285-1055
Mailing Address - Street 1:1003 YORK RD
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3116
Mailing Address - Country:US
Mailing Address - Phone:904-285-1055
Mailing Address - Fax:904-273-9573
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:904-285-1055
Practice Address - Fax:904-273-9573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1574095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105630Medicare ID - Type Unspecified