SUMMERVILLE AT MANDARIN, LLC (NPI# 1114253945) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114253945 |
| Entity Type | Organization |
| Organization Name | SUMMERVILLE AT MANDARIN, LLC |
| Other Organization Name | BROOKDALE MANDARIN |
| Practice Address |
10790 Old Saint Augustine Rd Jacksonville FL 32257-1078 |
| Mailing Address |
6737 W Washington St Suite 2300 Milwaukee WI 53214-5647 |
| Practice Telephone | 9042600800 |
| Enumeration Date | 2009-10-29 |
| Last Update Date | 2016-05-13 |
| Authorized Official Name | BRYAN RICHARDSON (EVP, CHIEF ADMIN. OFFICER) |
| Authorized Official Telephone | 6155648131 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | AL8789 | FL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 0118156-00 | 05 |
| Other Name | Type Code |
|---|---|
| Brookdale Mandarin | Doing Business As Name - Organization |
| Street Address |
10790 OLD SAINT AUGUSTINE RD |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32257-1078 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558538959 | Teresa L. Harris | Speech-Language Pathologist | 10790 Old Saint Augustine Rd, Jacksonville, FL 32257-1078 | 2008-05-14 |
| 1023371572 | Tina Marie Mclaughlin | Speech-Language Pathologist | 10790 Old Saint Augustine Rd, Jacksonville, FL 32257-1078 | 2012-06-20 |
| 1467750737 | Cynthia L Drown | Physical Therapist | 10790 Old Saint Augustine Rd, Jacksonville, FL 32257-1078 | 2011-03-10 |
| 1396040135 | Laura D Davis | Occupational Therapist | 10790 Old Saint Augustine Rd, Jacksonville, FL 32257-1078 | 2011-01-25 |
| 1366765406 | The Weston Group Inc | Occupational Therapist | 10790 Old Saint Augustine Rd, Jacksonville, FL 32257-1078 | 2010-03-03 |
| 1134452469 | Seema Bansal | Physical Therapist | 10790 Old Saint Augustine Rd, Jacksonville, FL 32257-1078 | 2009-09-18 |
| 1568604361 | Katerina A. Leverette | Occupational Therapist | 10790 Old Saint Augustine Rd, Jacksonville, FL 32257-1078 | 2009-03-26 |
| 1811139751 | Maria Teresa Santos | Physical Therapist | 10790 Old Saint Augustine Rd, Jacksonville, FL 32257-1078 | 2009-03-24 |
| 1073754115 | Erica Yvonne Williams | Occupational Therapist | 10790 Old Saint Augustine Rd, Jacksonville, FL 32257-1078 | 2009-03-19 |
| 1225278070 | Susan Veronica Rieger | Occupational Therapist | 10790 Old Saint Augustine Rd, Jacksonville, FL 32257-1078 | 2009-03-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740835842 | Majdoline Kasera | Pharmacist | 11250-4 Old St Augustine Rd, Jacksonville, FL 32257 | 2019-08-06 |
| 1386203859 | Jetaime Y Lewis | Physical Therapist | 9765 San Jose Blvd Ste 6, Jacksonville, FL 32257 | 2019-06-10 |
| 1437622107 | Michelle Espanol Garcia | Nurse Practitioner | 9957 Moorings Dr Ste 204, Jacksonville, FL 32257 | 2019-01-05 |
| 1982172995 | Pacifica Augustine Road LLC | Alzheimer Center (Dementia Center) | 10660 Old Augustine Road, Jacksonville, FL 32257 | 2018-11-07 |
| 1659860492 | Andrea Leigh Miller | Social Worker | 10416 Spotted Fawn Lane, Jacksonville, FL 32257 | 2018-05-08 |
| 1376049965 | Stephanie Lynne Jordon | Nurse Practitioner | 9765 San Jose Blvd Ste 102, Jacksonville, FL 32257 | 2018-04-02 |
| 1205335619 | Annetta Aileen Brown | Respite Care | 4901 Sunbeam Rd Apt 1016, Jacksonville, FL 32257 | 2018-02-12 |
| 1841714888 | Freda Stevens | Counselor | 9521 Shellie Road Unit 13, Jacksonville, FL 32257 | 2017-08-01 |
| 1659821353 | Jennifer Lavoro | Acupuncturist | 11259 Thomaston Pl, Jacksonville, FL 32257 | 2016-10-06 |
| 1225488232 | Avenues Dental LLC | Dentist | 6144 Gazebo Park Place South, Ste 210, Jacksonville, FL 32257 | 2016-06-21 |
| Find all providers in zip 32257 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902404668 | Tambolina Services Community Resident Home, Inc | Assisted Living Facility | 6285 Cranberry Ln W, Jacksonville, FL 32244-2559 | 2020-10-15 |
| 1316552284 | Enhanced Universal Care Alf | Assisted Living Facility | 10967 Key Haven Blvd, Jacksonville, FL 32218-4463 | 2020-09-08 |
| 1710527270 | Rosecastle of Jacksonville LLC | Assisted Living Facility | 8929 R G Skinner Pkwy, Jacksonville, FL 32256-9724 | 2020-01-13 |
| 1891353777 | V & K Horizons | Assisted Living Facility | 7019 Mark St, Jacksonville, FL 32210-4889 | 2019-06-05 |
| 1144784638 | Carole Stallworth | Assisted Living Facility | 5116 Mcmanus Dr, Jacksonville, FL 32210-6353 | 2019-01-29 |
| 1467921569 | Heart To Heart LLC | Assisted Living Facility | 9378 Arlignton Expressway, Ste 218, Jacksonville, FL 32225 | 2018-11-19 |
| 1073090437 | Lashonda Oglesby | Assisted Living Facility | 6313 Arlington Rd, Jacksonville, FL 32211-5423 | 2018-07-27 |
| 1831697218 | Cortney Irene Matthews | Assisted Living Facility | 3109 Gilmore St, Jacksonville, FL 32205-5516 | 2018-01-31 |
| 1093222515 | Anthem Lakes | Assisted Living Facility | 905 Assisi Ln, Jacksonville, FL 32233-2972 | 2018-01-05 |
| 1831608975 | Silver Shores Living, Inc | Assisted Living Facility | 2317 Gilmore St, Jacksonville, FL 32204-3119 | 2017-09-20 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32257 |
Please comment or provide details below to improve the information on SUMMERVILLE AT MANDARIN, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.