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BROOKDALE MANDARIN
NPI 1114253945
Assisted Living Facility in Jacksonville, FL

Active since October 29, 2009CLIA 10D1053217 · Waiver
10790 OLD SAINT AUGUSTINE RD, JACKSONVILLE, FL 32257(904) 260-0800 Get Directions Write a Review

NPPES record last updated: May 13, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Brookdale Mandarin NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BROOKDALE MANDARIN (NPI 1114253945) is a healthcare organization registered as an assisted living facility in Jacksonville, Florida and active in the NPI registry since October 2009. The organization holds a CLIA Waiver certificate valid through February 2, 2027 and lists Bryan Richardson, Evp, Chief Admin. Officer, as its authorized official.

NPPES Registry Identity

NPI1114253945
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSUMMERVILLE AT MANDARIN, LLC
Location Address10790 OLD SAINT AUGUSTINE RDJacksonville, FL 32257-1078
Mailing Address6737 W Washington St, Suite 2300Milwaukee, WI 53214-5647
Phone(904) 260-0800
Organization SubpartNo
Authorized OfficialBryan RichardsonEvp, Chief Admin. Officer · (615) 564-8131
Enumeration DateOctober 29, 2009
Last NPPES UpdateMay 13, 2016
✔ NPI 1114253945 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in FL · AL8789
Definition
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.
10790 OLD SAINT AUGUSTINE RD, Jacksonville, FL 32257
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Other Names 1

Doing Business AsBrookdale Mandarin

Other Identifiers 1

Medicaid0118156-00FL

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D1053217

Brookdale Mandarin · Jacksonville, FL
Active · expires Feb 2, 2027
CLIA Number10D1053217
Laboratory TypeAssisted Living Facility
Certificate Effective DateFebruary 3, 2025
Certificate Expiration DateFebruary 2, 2027
Laboratory DirectorChristi A. Hall
Laboratory Phone(904) 260-0800
Laboratory LocationBrookdale Mandarin10790 Old St Augustine Rd, Jacksonville, FL 32257
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TINA MARIE MCLAUGHLIN MA CCC/SLP
Speech-Language Pathologist
10790 OLD SAINT AUGUSTINE RD
JACKSONVILLE, FL 32257
Duval County (904) 262-2286
ERICA YVONNE WILLIAMS OT
Occupational Therapist
10790 OLD SAINT AUGUSTINE RD
JACKSONVILLE, FL 32257
Duval County (904) 260-0800
SEEMA BANSAL PT
Physical Therapist
10790 OLD SAINT AUGUSTINE RD
JACKSONVILLE, FL 32257
Duval County (904) 260-0800
SUSAN VERONICA RIEGER OTR/L, CHT
Occupational Therapist
10790 OLD SAINT AUGUSTINE RD
JACKSONVILLE, FL 32257
Duval County (904) 260-0800
SHAWN DAVID DROWN MOTR/L
Occupational Therapist
10790 OLD SAINT AUGUSTINE RD
JACKSONVILLE, FL 32257
Duval County (904) 260-0800
ELIZABETH J RAVENSBERGEN-OOLE PT
Physical Therapist
10790 OLD SAINT AUGUSTINE RD
JACKSONVILLE, FL 32257
Duval County (904) 260-0800
LAURA D DAVIS OT
Occupational Therapist
10790 OLD SAINT AUGUSTINE RD
JACKSONVILLE, FL 32257
Duval County (904) 262-2286
CYNTHIA L DROWN PT
Physical Therapist
10790 OLD SAINT AUGUSTINE RD
JACKSONVILLE, FL 32257
Duval County (904) 262-2286

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Summerville At Mandarin, LLC's NPI number?

The NPI number for Summerville At Mandarin, LLC is 1114253945. It was assigned to this organization in the NPPES registry on October 29, 2009. The provider is doing business as Brookdale Mandarin.

Where is Summerville At Mandarin, LLC located?

Summerville At Mandarin, LLC is located at 10790 Old Saint Augustine Rd, Jacksonville, FL 32257. The listed phone number is (904) 260-0800.

What is Summerville At Mandarin, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Summerville At Mandarin, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D1053217) is associated with this NPI, valid through February 2, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Summerville At Mandarin, LLC was last updated on May 13, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.