Provider Demographics
NPI:1942298849
Name:ALL SAINTS NURSING HOME & REHAB. CENTER, INC.
Entity Type:Organization
Organization Name:ALL SAINTS NURSING HOME & REHAB. CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-772-1220
Mailing Address - Street 1:5888 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-1927
Mailing Address - Country:US
Mailing Address - Phone:904-772-1220
Mailing Address - Fax:904-772-6334
Practice Address - Street 1:5888 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-1927
Practice Address - Country:US
Practice Address - Phone:904-772-1220
Practice Address - Fax:904-772-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1007096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41601OtherAHCA
FLK6QOtherBLUE CROSS & BLUE SHIELD
FL020073500Medicaid
FL41601OtherAHCA