Provider Demographics
NPI:1619964608
Name:4 JS INC
Entity Type:Organization
Organization Name:4 JS INC
Other - Org Name:WOODCREST MANOR ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NILDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT
Authorized Official - Phone:727-686-4223
Mailing Address - Street 1:1735 JEFFORDS ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4560
Mailing Address - Country:US
Mailing Address - Phone:727-447-8558
Mailing Address - Fax:727-447-8558
Practice Address - Street 1:1735 JEFFORDS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4560
Practice Address - Country:US
Practice Address - Phone:727-447-8558
Practice Address - Fax:727-447-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5034310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility