Provider Demographics
NPI:1538418249
Name:NORTHERN JACKSONVILLE ACQUISITIONS, LLC
Entity type:Organization
Organization Name:NORTHERN JACKSONVILLE ACQUISITIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-207-2108
Mailing Address - Street 1:5377 MONCRIEF RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-3159
Mailing Address - Country:US
Mailing Address - Phone:786-207-2108
Mailing Address - Fax:866-293-2100
Practice Address - Street 1:5377 MONCRIEF RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-3159
Practice Address - Country:US
Practice Address - Phone:786-207-2108
Practice Address - Fax:866-293-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314000000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005978300Medicaid
FL10-5138OtherMEDICARE PTAN