Organization
JACARANDA MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERRI M WALKER NHA (ADMINISTRATOR)
(727) 546-2405
Entity
Organization
Contact information
Practice address
4250 66TH ST N, KENNETH CITY, FL 33709-4918
(727) 546-2405
(727) 541-5154
Mailing address
4250 66TH ST N, KENNETH CITY, FL 33709-4918
(727) 546-2405
(727) 541-5154
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1252096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SNF1252096
LICENSE NUMBER
FL
Enumeration date
07/12/2005
Last updated
08/22/2020
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