Provider Demographics
NPI:1538595657
Name:ORANGE PARK ASSISTED LIVING FACILITY, INC.
Entity type:Organization
Organization Name:ORANGE PARK ASSISTED LIVING FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-673-1419
Mailing Address - Street 1:2485 RIDGECREST AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-6236
Mailing Address - Country:US
Mailing Address - Phone:904-276-6644
Mailing Address - Fax:904-276-6644
Practice Address - Street 1:2485 RIDGECREST AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-6236
Practice Address - Country:US
Practice Address - Phone:904-276-6644
Practice Address - Fax:904-276-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12390310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility