Provider Demographics
NPI:1588821805
Name:JE NURSING CENTER LLC
Entity Type:Organization
Organization Name:JE NURSING CENTER LLC
Other - Org Name:JEFFERSON NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBAINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-864-9191
Mailing Address - Street 1:1780 N JEFFERSON
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-5536
Mailing Address - Country:US
Mailing Address - Phone:850-997-2313
Mailing Address - Fax:
Practice Address - Street 1:1780 N JEFFERSON
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-5536
Practice Address - Country:US
Practice Address - Phone:850-997-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1257096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021400100Medicaid
FL105802Medicare Oscar/Certification