Provider Demographics
NPI:1639578933
Name:NOBLE GARDENS OF JACKSONVILLE, LLC
Entity Type:Organization
Organization Name:NOBLE GARDENS OF JACKSONVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LALAINE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CATE
Authorized Official - Suffix:
Authorized Official - Credentials:GRADUATE
Authorized Official - Phone:904-374-2071
Mailing Address - Street 1:7024 WILEY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2736
Mailing Address - Country:US
Mailing Address - Phone:904-374-2071
Mailing Address - Fax:904-374-2236
Practice Address - Street 1:7024 WILEY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2736
Practice Address - Country:US
Practice Address - Phone:904-374-2071
Practice Address - Fax:904-374-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12207310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility