Organization
LIFE CARE PONTE VEDRA INC
Active
Other names
Vicars Landing
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND M JOHNSON (EXECUTIVE DIRECTOR)
(904) 273-1701
Entity
Organization
Contact information
Practice address
1003 YORK RD, PONTE VEDRA BEACH, FL 32082
(904) 285-1055
(904) 285-1384
Mailing address
1000 VICARS LANDING WAY, PONTE VEDRA BEACH, FL 32082
(904) 273-1701
(904) 285-1384
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1574095
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105630
OSCAR
FL
Enumeration date
08/09/2006
Last updated
04/13/2009
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