Organization
FLORIDA DEPARTMENT OF VETERANS AFFAIRS
Active
Other names
Douglas Jacobson State Veterans Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM G PUCKETT (PROGRAM DIRECTOR)
(727) 518-3202
Entity
Organization
Contact information
Practice address
21281 GRAYTON TER, PORT CHARLOTTE, FL 33954-3109
(941) 613-0919
(941) 613-0935
Mailing address
21281 GRAYTON TER, PORT CHARLOTTE, FL 33954-3109
(941) 613-0919
(941) 613-0935
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
—
FL
314000000X
Skilled Nursing Facility
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M4J
BCBS
FL
Enumeration date
08/19/2005
Last updated
09/11/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us