Provider Demographics
NPI:1700558947
Name:FOXCARE AT LAKESIDE LLC
Entity Type:Organization
Organization Name:FOXCARE AT LAKESIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, MBA
Authorized Official - Phone:813-758-9263
Mailing Address - Street 1:2380 SADLER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-0415
Mailing Address - Country:US
Mailing Address - Phone:904-321-1909
Mailing Address - Fax:904-321-1790
Practice Address - Street 1:11411 ARMSDALE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-3311
Practice Address - Country:US
Practice Address - Phone:904-714-3793
Practice Address - Fax:904-714-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility