Organization
ST JOHNS COUNTY WELFARE FEDERATION
Active
Other names
Samantha Wilson Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY LAKE PHD, NHA (ADMINISTRATOR)
(904) 824-2501
Entity
Organization
Contact information
Practice address
161 MARINE ST, ST AUGUSTINE, FL 32084-5154
(904) 829-3475
(904) 808-9908
Mailing address
161 MARINE ST, ST AUGUSTINE, FL 32084-5154
(904) 829-3475
(904) 808-9908
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1489096
FL
Other
Enumeration date
01/26/2007
Last updated
08/22/2020
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