Provider Demographics
NPI:1437565348
Name:GRAND OAKS OF JENSEN BEACH, LLC
Entity Type:Organization
Organization Name:GRAND OAKS OF JENSEN BEACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALF ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-286-1844
Mailing Address - Street 1:2400 SE MONTEREY RD
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3351
Mailing Address - Country:US
Mailing Address - Phone:772-286-1844
Mailing Address - Fax:772-286-8753
Practice Address - Street 1:125 NW JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4486
Practice Address - Country:US
Practice Address - Phone:772-286-1844
Practice Address - Fax:772-286-8758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility