Provider Demographics
NPI:1861477119
Name:SV - JUPITER PROPERTIES INC
Entity Type:Organization
Organization Name:SV - JUPITER PROPERTIES INC
Other - Org Name:JUPITER CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL FIELD AUDITOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-376-7176
Mailing Address - Street 1:17781 THELMA AVE
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7942
Mailing Address - Country:US
Mailing Address - Phone:561-746-2998
Mailing Address - Fax:561-746-9866
Practice Address - Street 1:17781 THELMA AVE
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7942
Practice Address - Country:US
Practice Address - Phone:561-746-2998
Practice Address - Fax:561-746-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF12620962314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022492800Medicaid
FL105555Medicare Oscar/Certification
5089760003Medicare NSC