Organization
ST CATHERINE LABOURE MANOR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT WHALEN (CHIEF EXECUTIVE OFFICER)
(904) 308-8194
Entity
Organization
Contact information
Practice address
1750 STOCKTON ST, JACKSONVILLE, FL 32204-4664
(904) 308-7300
Mailing address
1750 STOCKTON ST, JACKSONVILLE, FL 32204-4664
(904) 308-7300
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1517096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020515000
—
FL
01
—
0804730001
DME MAC
FL
01
—
K77
BCBS
FL
Enumeration date
09/06/2006
Last updated
05/12/2009
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