Provider Demographics
NPI:1285077248
Name:SPRING GARDENS OF ORANGE PARK
Entity type:Organization
Organization Name:SPRING GARDENS OF ORANGE PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DORINDA
Authorized Official - Middle Name:JENIPHER
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-891-8793
Mailing Address - Street 1:2550 SANDLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-8928
Mailing Address - Country:US
Mailing Address - Phone:904-276-1778
Mailing Address - Fax:888-736-5589
Practice Address - Street 1:2550 SANDLEWOOD CIR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-8928
Practice Address - Country:US
Practice Address - Phone:904-276-1778
Practice Address - Fax:888-736-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12321310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility