Organization
JACOBSLADDER FAMILY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAROLENA MARIE DECLERCQ R.N. (ADMINISTRATOR)
(321) 223-3967
Entity
Organization
Contact information
Practice address
946 BRUNSWICK LN, ROCKLEDGE, FL 32955-4070
(321) 223-3967
Mailing address
946 BRUNSWICK LN, ROCKLEDGE, FL 32955-4070
(321) 223-3967
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL11180
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL11180
AGENCY FOR HEALTH CARE ADMINISTRATION
FL
Enumeration date
05/14/2012
Last updated
05/14/2012
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