Organization
LLIINGLESIDE RETIREMENT HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAJAD ALLI (PRESIDENT)
(904) 389-6677
Entity
Organization
Contact information
Practice address
1433 INGLESIDE AVE, JACKSONVILLE, FL 32205-7712
(904) 389-6677
(904) 389-7011
Mailing address
1433 INGLESIDE AVE, JACKSONVILLE, FL 32205-7712
(904) 389-6677
(904) 389-7011
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL5576
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001119000
—
FL
Enumeration date
12/06/2010
Last updated
12/06/2010
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