Provider Demographics
NPI:1447639216
Name:ANAM PARC, LLC.
Entity type:Organization
Organization Name:ANAM PARC, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GLAVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-610-6602
Mailing Address - Street 1:3604 CARDINAL POINT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5581
Mailing Address - Country:US
Mailing Address - Phone:904-610-6602
Mailing Address - Fax:904-731-0002
Practice Address - Street 1:4294 TANGLEWILDE DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6439
Practice Address - Country:US
Practice Address - Phone:904-610-6602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANAM PARC, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12145310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility