Provider Demographics
NPI:1982206645
Name:JAX SENIOR CARE LLC
Entity Type:Organization
Organization Name:JAX SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-326-0900
Mailing Address - Street 1:119 DA VINCI BLVD
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-8821
Mailing Address - Country:US
Mailing Address - Phone:904-326-0900
Mailing Address - Fax:904-326-0913
Practice Address - Street 1:119 DA VINCI BLVD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-8821
Practice Address - Country:US
Practice Address - Phone:904-326-0900
Practice Address - Fax:904-326-0913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility