Organization Name: | JBA SVCS INC D/B/A IMMACULATE HOUSE AT COUNTRYSIDE |
NPI Number: | 1710154604 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOANNE BOCK-ACKERMAN (ALF ADMINISTRATOR) |
Mailing Address: | 2542 Countryside Pines Dr Clearwater |
State: | FL US |
Postal Code: | 337614921 |
Phone Number: | 7279344310 |
Fax Number: | 7279432075 |
NPI Enumeration Date: | 05/10/2008 |
NPI Last Update Date: | 05/10/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | AL 11233 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | 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. |