Provider Demographics
NPI:1659050722
Name:SAN JOSE BLVD OPCO LLC
Entity Type:Organization
Organization Name:SAN JOSE BLVD OPCO LLC
Other - Org Name:ASPIRE AT SAN JOSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-730-7480
Mailing Address - Street 1:9355 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5503
Mailing Address - Country:US
Mailing Address - Phone:904-739-0877
Mailing Address - Fax:904-448-9253
Practice Address - Street 1:9355 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5503
Practice Address - Country:US
Practice Address - Phone:904-739-0877
Practice Address - Fax:904-448-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility