Provider Demographics
NPI:1902109010
Name:J & S ADULT LIVIVNG FACILITY
Entity Type:Organization
Organization Name:J & S ADULT LIVIVNG FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-938-1336
Mailing Address - Street 1:1343 JOHNS ST.
Mailing Address - Street 2:
Mailing Address - City:JENNING
Mailing Address - State:FL
Mailing Address - Zip Code:32053
Mailing Address - Country:US
Mailing Address - Phone:386-938-1336
Mailing Address - Fax:386-938-2751
Practice Address - Street 1:1343 JOHNS ST
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:FL
Practice Address - Zip Code:32053-3097
Practice Address - Country:US
Practice Address - Phone:386-938-1336
Practice Address - Fax:386-938-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL110063104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1429337Medicaid