10D0926743 CLIA NUMBER - BROOKDALE MANDARIN CENTRAL

Laboratory Demographics

CLIA Number: 10D0926743

Facility Name: BROOKDALE MANDARIN CENTRAL

Facility Address:
10875 OLD ST AUGUSTINE RD
JACKSONVILLE, FL
ZIP 32257
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Facility Phone Number: 904 880-4040

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1679875066

Taxonomy: 310400000X - 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.

CLIA Record

Field Name	Field Value
CLIA Number	10D0926743
LAB Type	Other
Facility Name	BROOKDALE MANDARIN CENTRAL
Street	10875 OLD ST AUGUSTINE RD
City	JACKSONVILLE
State	FL
ZIP	32257
Phone	904 880-4040
CertificateType	4
CertificateEffectiveDate	3/31/2023
CertificateExpirationDate	3/30/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024