Organization
PETERSON ASSISTED LIVING FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAVERNE JACKSON (DIRECTOR OF OPERATION)
(904) 356-3922
Entity
Organization
Contact information
Practice address
1622 SILVER ST, JACKSONVILLE, FL 32206-4446
(904) 356-3022
(904) 350-9165
Mailing address
1622 SILVER ST, JACKSONVILLE, FL 32206-4446
(904) 356-3022
(904) 350-9165
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL8638
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140750300
—
FL
Enumeration date
05/29/2013
Last updated
05/29/2013
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