Provider Demographics
NPI:1831608975
Name:SILVER SHORES LIVING, INC
Entity type:Organization
Organization Name:SILVER SHORES LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARFIELD
Authorized Official - Middle Name:ST AUBURN
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-683-1580
Mailing Address - Street 1:2317 GILMORE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3119
Mailing Address - Country:US
Mailing Address - Phone:904-683-1580
Mailing Address - Fax:
Practice Address - Street 1:2317 GILMORE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3119
Practice Address - Country:US
Practice Address - Phone:904-683-1580
Practice Address - Fax:904-683-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12806310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL12806OtherAGENCY FOR HEALTHCARE ADMINISTRATION (ALF LICENSE)
FL018329800Medicaid