Provider Demographics
NPI:1730711219
Name:NORTH FLORIDA SENIOR LIVING LLC
Entity type:Organization
Organization Name:NORTH FLORIDA SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EVGENY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-635-6081
Mailing Address - Street 1:614 BOWLES CT
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-3602
Mailing Address - Country:US
Mailing Address - Phone:904-635-6081
Mailing Address - Fax:
Practice Address - Street 1:541103 LEM TURNER RD
Practice Address - Street 2:
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011-8546
Practice Address - Country:US
Practice Address - Phone:904-635-6081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances