GOLDEN RETREAT SHELTER CARE CENTER, INC. (NPI# 1245643915) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245643915 |
| Entity Type | Organization |
| Organization Name | GOLDEN RETREAT SHELTER CARE CENTER, INC. |
| Practice Address |
4410 Moncrief Rd W Jacksonville FL 32209-1228 |
| Practice Telephone | 9047642581 |
| Mailing Telephone | 9047642581 |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |
| Authorized Official Name | ABDULLAH SHAH (OWNER) |
| Authorized Official Telephone | 9047642581 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
AL5846 | FL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 141158600 | 05 |
| Street Address |
4410 MONCRIEF RD W |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32209-1228 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710506183 | Hayley M Shade | Student in an Organized Health Care Education/Training Program | 655 8th St. W., 4th Floor, Lrc 653-1 West 8th Street, L18, Jacksonville, FL 32209 | 2020-04-15 |
| 1407484629 | Micah Christine Turpeau | Student in an Organized Health Care Education/Training Program | 580 W. 8th St., Tower II, Suite 6005, Jacksonville, FL 32209 | 2020-04-01 |
| 1730716366 | Nikki Javia | Student in an Organized Health Care Education/Training Program | 653-1 W 8th St, Fl 4, Lrc Box L16, Jacksonville, FL 32209 | 2020-03-24 |
| 1336776061 | Samuel Kamoroff | Student in an Organized Health Care Education/Training Program | 653-1 West 8th Street, 4th Floor, Lrc Box L16, Jacksonville, FL 32209 | 2020-03-24 |
| 1376194092 | Donald Wayne Johnson Jr. | Pharmacist | Uf Health Jacksonville, 655 West 8th Street, Jacksonville, FL 32209 | 2019-09-24 |
| 1871141838 | Anton Daran Armstrong | Counselor | 921 N. Davis St. Bldg. B, Suite 350, Jacksonville, FL 32209 | 2019-09-03 |
| 1295296499 | Christian King | Student in an Organized Health Care Education/Training Program | 580 W. 8th St., Tower II, Suite 6005, Jacksonville, FL 32209 | 2019-03-29 |
| 1013478403 | David William Barton | Orthopaedic Surgery | 655 W 8th St, Box C-126, Jacksonville, FL 32209 | 2019-03-27 |
| 1912497108 | Lisa Jordan | Adult Companion | 1515 W 31st St, Jacksonville, FL 32209 | 2018-05-14 |
| 1275020968 | Eloisa Anne Ello-esma | Nurse Practitioner | W. 8th Street, Jacksonville, FL 32209 | 2018-04-18 |
| Find all providers in zip 32209 | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548826480 | Comfort Alf LLC | Assisted Living Facility | 2122 N Myrtle Ave, Jacksonville, FL 32209-5633 | 2019-05-16 |
| 1194113670 | Bishop Home Care Inc | Assisted Living Facility | 16308 Magnolia Grove Way, Jacksonville, FL 32218-0116 | 2015-01-06 |
| 1861896284 | Stephanie's Love & Care (alf) | Assisted Living Facility | 3056 W 1st St, Jacksonville, FL 32254-2539 | 2014-10-14 |
| 1952714404 | Ivan Maldonado | Assisted Living Facility | 6320 Arlington Rd, Jacksonville, FL 32211-5430 | 2014-06-03 |
| 1215353370 | Arlington Adult Residential Facility, Inc. | Assisted Living Facility | 6300 Arlington Expy, Jacksonville, FL 32211-7144 | 2014-03-13 |
| 1679997704 | Watts Guardian Care, Inc. | Assisted Living Facility | 7217 Eudine Dr N, Jacksonville, FL 32210-2628 | 2014-02-10 |
| 1164868923 | Circle of Hope Inc | Assisted Living Facility | 1550 W 9th St, Jacksonville, FL 32209-5410 | 2013-05-20 |
| 1851736540 | Autumn Village, Inc. | Assisted Living Facility | 1103 Barrs Street, Jacksonville, FL 32204 | 2013-05-08 |
| 1265780274 | Wiley Retirement Home | Assisted Living Facility | 7024 Wiley Rd, Jacksonville, FL 32210-2736 | 2012-08-22 |
| 1447567540 | Second Beginnings Alf | Assisted Living Facility | 7306 Maple Tree Dr, Jacksonville, FL 32277-2806 | 2010-09-10 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32209 |
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| 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.