Provider Demographics
NPI:1780059931
Name:SPRING GARDENS OF FLEMING ISLAND, LLC
Entity type:Organization
Organization Name:SPRING GARDENS OF FLEMING ISLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-386-6636
Mailing Address - Street 1:670 HIBERNIA RD
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4570
Mailing Address - Country:US
Mailing Address - Phone:904-657-2240
Mailing Address - Fax:888-736-5589
Practice Address - Street 1:670 HIBERNIA RD
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4570
Practice Address - Country:US
Practice Address - Phone:904-657-2240
Practice Address - Fax:888-736-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12759310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility