1326362005 NPI number — BROOKS SKILLED NURSING FACILITY, A, INC.

Table of content: (NPI 1326362005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326362005 NPI number — BROOKS SKILLED NURSING FACILITY, A, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKS SKILLED NURSING FACILITY, A, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BARTRAM CROSSING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326362005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3599 UNIVERSITY BLVD S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-4252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-345-7607
Provider Business Mailing Address Fax Number:
904-345-7284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6209 BROOKS BARTRAM DR. BLDG 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-528-3000
Provider Business Practice Location Address Fax Number:
904-345-7284
Provider Enumeration Date:
03/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BAER
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT & CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
904-345-7473

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 427289 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008699000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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