Provider Demographics
NPI:1659448306
Name:CARE CENTERS OF NASSAU, LLC
Entity Type:Organization
Organization Name:CARE CENTERS OF NASSAU, LLC
Other - Org Name:GF AMELIA ISLAND PROPERTIES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-261-5518
Mailing Address - Street 1:95146 HENDRICKS RD
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034
Mailing Address - Country:US
Mailing Address - Phone:904-261-5518
Mailing Address - Fax:904-261-5517
Practice Address - Street 1:95146 HENDRICKS RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:904-261-5518
Practice Address - Fax:904-261-5517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4010096315P00000X
FL40950955315P00000X
FL40950956315P00000X
FL028539100315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL028539100Medicaid
FL028539196Medicaid