Provider Demographics
NPI:1578199303
Name:FIRST COAST HEALTH VENTURES, LLC
Entity Type:Organization
Organization Name:FIRST COAST HEALTH VENTURES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNESLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRIGHTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-753-1870
Mailing Address - Street 1:PO BOX 15369
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-3107
Mailing Address - Country:US
Mailing Address - Phone:904-321-1909
Mailing Address - Fax:904-321-1790
Practice Address - Street 1:15480 MAX LEGGETT PARKWAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218
Practice Address - Country:US
Practice Address - Phone:904-321-1909
Practice Address - Fax:904-321-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility