IndividualActive
Mary Peterson, ADMINISTRATOR
NPI 1063221646 · Assisted Living Facility · Jacksonville, FL
Provider details
- NPI number
- 1063221646
- Entity type
- Individual
- Primary specialty
- Assisted Living FacilityNursing & Custodial Care Facilities
- Credential
- ADMINISTRATOR
- Sex
- Female
- Sole proprietor
- Yes
- License
- 8638 (FL)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Established profile(55/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
1 yr in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1622 Silver St
Jacksonville, FL 32206-4446
Phone: (904) 356-3022
Fax: (904) 350-9165
Street-level locationGet directions
Mailing address
1622 Silver St
Jacksonville, FL 32206-4446
Registry dates
- Enumerated
- 2025-01-07
- Last updated
- 2025-01-07
- Certified
- 2025-01-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.