Organization · Type 2 NPI

Jba SVCS Inc D/b/a Immaculate House at Countryside

Assisted Living Facility · Clearwater, FL

NPI number 1710154604 Active

Practice location

2542 Countryside Pines Dr
Clearwater, FL 33761-4921

Call (727) 934-4310 Map

Fax (727) 943-2075

Mailing address

3823 Pendlebury Dr
Palm Harbor, FL 34685-2670

Specialties and licenses

Taxonomy	Code	License
Assisted Living Facility Primary	310400000X	AL 11233 (FL)

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.

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NPI record

NPI: 1710154604
Entity type: Organization (Type 2)
Issued: May 10, 2008
Last updated: May 10, 2008
Status: Active
Subpart: Yes of Jba SVCS Inc D/b/a Forest Hills Home at Palm Harbor

Other names

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Forest Hills Home at Palm Harbor · doing business as

Authorized official

Ms. Joanne Bock-Ackerman, AHCA ALF ADMIN.
Alf Administrator
(727) 934-4310

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1710154604

Jba SVCS Inc D/b/a Immaculate House at Countryside's National Provider Identifier is 1710154604, issued on May 10, 2008. The primary taxonomy on file is Assisted Living Facility (310400000X), and the practice location is in Clearwater, FL. The record was last updated on May 10, 2008.