Provider Demographics
NPI:1336418946
Name:THE TERRACE AT IVEY ACRES OF JAY
Entity Type:Organization
Organization Name:THE TERRACE AT IVEY ACRES OF JAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-995-5000
Mailing Address - Street 1:3964 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565
Mailing Address - Country:US
Mailing Address - Phone:850-675-4000
Mailing Address - Fax:850-675-4001
Practice Address - Street 1:3964 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565
Practice Address - Country:US
Practice Address - Phone:850-675-4000
Practice Address - Fax:850-675-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12076310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility