Organization
ANTHEM LAKES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHNPAUL LOUIS GOODE (OPERATIONS LIAISON)
(804) 839-6946
Entity
Organization
Contact information
Practice address
905 ASSISI LN, JACKSONVILLE, FL 32233-2972
(904) 746-7220
Mailing address
905 ASSISI LN, JACKSONVILLE, FL 32233-2972
(904) 746-7220
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
12972
—
Other
Enumeration date
01/05/2018
Last updated
01/05/2018
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