Basic Information
| Provider Information | |||||||||
| NPI: | 1700558947 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOXCARE AT LAKESIDE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2380 SADLER RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | FERNANDINA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320340415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043211909 | ||||||||
| FaxNumber: | 9043211790 | ||||||||
| Practice Location | |||||||||
| Address1: | 11411 ARMSDALE RD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322183311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047143793 | ||||||||
| FaxNumber: | 9047143799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2021 | ||||||||
| LastUpdateDate: | 10/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | MEAD | ||||||||
| AuthorizedOfficialFirstName: | BETSY | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8137589263 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN, MSN, MBA | ||||||||
| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.