Organization
TERRACE OF JACKSONVILLE LLC
Active
Other names
The Terrace of Jacksonville
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY DEGROSS (ADMINISTRATOR)
(904) 268-4953
Entity
Organization
Contact information
Practice address
10680 OLD SAINT AUGUSTINE RD, JACKSONVILLE, FL 32257-1000
(904) 268-4953
(904) 268-3431
Mailing address
10680 OLD SAINT AUGUSTINE RD, JACKSONVILLE, FL 32257-1000
(904) 268-4953
(904) 268-3431
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF13060961
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031237100
—
FL
Enumeration date
03/31/2014
Last updated
10/27/2014
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