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Organization
FLORIDA DEPARTMENT OF VETERANS AFFAIRS
Active
Organization
FLORIDA DEPARTMENT OF VETERANS AFFAIRS
Active
Other names
Douglas T. Jacobson State Veterans Nursing Home, Douglas Jacobson State Veterans Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM G PUCKETT (PROGRAM DIRECTOR)
(727) 518-3202
Entity
Organization
Contact information
Practice address
21281 GRAYTON TER, PORT CHARLOTTE, FL 33954-3109
(941) 613-0919
(941) 613-0935
Mailing address
21281 GRAYTON TER, PORT CHARLOTTE, FL 33954-3109
(941) 613-0919
(941) 613-0935
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
SNF130471029
FL
314000000X
Skilled Nursing Facility
SNF130471029
FL
Other
Enumeration date
08/19/2005
Last updated
07/08/2026
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