Provider Demographics
NPI:1205258852
Name:GWK HOME OF COMFORT LLC
Entity type:Organization
Organization Name:GWK HOME OF COMFORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SASSNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-695-2673
Mailing Address - Street 1:7944 CECIL ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-6707
Mailing Address - Country:US
Mailing Address - Phone:904-695-2673
Mailing Address - Fax:904-695-2673
Practice Address - Street 1:7944 CECIL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-6707
Practice Address - Country:US
Practice Address - Phone:904-695-2673
Practice Address - Fax:904-695-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility