Provider Demographics
NPI:1154133296
Name:THE PALISADES AT EWU
Entity type:Organization
Organization Name:THE PALISADES AT EWU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENKENYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-610-5628
Mailing Address - Street 1:77007 MERRILL RD
Mailing Address - Street 2:UNIT 8309
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277
Mailing Address - Country:US
Mailing Address - Phone:904-610-5628
Mailing Address - Fax:
Practice Address - Street 1:1156 W 4TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-7704
Practice Address - Country:US
Practice Address - Phone:904-610-5628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R.O.B. PROPERTIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility