Organization
SAMSON VILLA OF ORANGE PARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL CORBETT GRANGER II (OWNER/ADMINISTRATOR)
(904) 755-8707
Entity
Organization
Contact information
Practice address
2757 PEBBLERIDGE CT, ORANGE PARK, FL 32065-6261
(904) 375-2011
Mailing address
2757 PEBBLERIDGE COURT, ORANGE PARK, FL 32065
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12338
FL
Other
Enumeration date
08/29/2013
Last updated
08/29/2013
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