Provider Demographics
NPI:1467878454
Name:HENDRIX, SMITH, & KIRBY LLC D/B/A EASTSIDE CARE ALF
Entity Type:Organization
Organization Name:HENDRIX, SMITH, & KIRBY LLC D/B/A EASTSIDE CARE ALF
Other - Org Name:EASTSIDE CARE, ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL AREA ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-688-9318
Mailing Address - Street 1:152 SE DEFENDER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-4990
Mailing Address - Country:US
Mailing Address - Phone:386-755-4487
Mailing Address - Fax:
Practice Address - Street 1:152 SE DEFENDER DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-4990
Practice Address - Country:US
Practice Address - Phone:386-755-4487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5425310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108713000Medicaid
FL111674400Medicaid
FL142186700Medicaid