Provider Demographics
NPI:1336253020
Name:ACV HEALTH SERVICES L L C
Entity Type:Organization
Organization Name:ACV HEALTH SERVICES L L C
Other - Org Name:GOOD SAMARITAN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAG
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-658-5500
Mailing Address - Street 1:PO BOX 4674
Mailing Address - Street 2:
Mailing Address - City:DOWLING PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-1507
Mailing Address - Country:US
Mailing Address - Phone:386-658-5450
Mailing Address - Fax:386-658-5111
Practice Address - Street 1:10676 MARVIN JONES BLVD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-8242
Practice Address - Country:US
Practice Address - Phone:386-658-5550
Practice Address - Fax:386-658-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1178096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026876300Medicaid
FLL3ZOtherBCBS UB92
FL105809Medicare Oscar/Certification