HAMPTON MANOR OF ORMOND BEACH LLC
NPI 1184944472
Assisted Living Facility in Ormond Beach, FL

Active since June 09, 2010
1050 OCEAN SHORE BLVD, ORMOND BEACH, FL 32176(386) 441-1771(386) 441-1778 Get Directions Write a Review

NPPES record last updated: June 9, 2010. Verified against the NPPES registry weekly; last sync: July 19, 2026.

  • Organization
  • Assisted Living Facility
  • CLIA Number: 10D2078183
  • CLIA Cert. Type: Assisted Living Facility
  • CLIA Exp. Date: 05-21-2026

About HAMPTON MANOR OF ORMOND BEACH LLC

This page provides the complete NPI Profile along with additional information for Hampton Manor Of Ormond Beach Llc, a provider established in Ormond Beach, Florida operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1184944472 assigned on June 2010. The practitioner's primary taxonomy code is 310400000X with license number AL8860 (FL). The provider is registered as an organization and their NPI record was last updated 16 years ago. The authorized official of this NPI record is Peder Johnsen (Ceo)

NPI
1184944472 Verify this NPI
Provider Name
HAMPTON MANOR OF ORMOND BEACH LLC
Entity Type
Organization
Location Address
1050 OCEAN SHORE BLVD ORMOND BEACH, FL 32176
Location Phone
(386) 441-1771
Location Fax
(386) 441-1778
Mailing Address
1050 OCEAN SHORE BLVD ORMOND BEACH, FL 32176
Mailing Phone
(386) 441-1771
Mailing Fax
(386) 441-1778
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
06-09-2010
Last Update Date
06-09-2010
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Assisted Living Facility

Taxonomy Code
310400000X
Type
Nursing & Custodial Care Facilities
License No.
AL8860
License State
FL
Taxonomy Description
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.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

PEDER JOHNSEN

Authorized Official Title
CEO
Authorized Official Phone
(352) 387-1830

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
10D2078183
Facility Type
Assisted Living Facility
Certificate Effective Date
May 22, 2024
Certificate Expiration Date
May 21, 2026
Laboratory Director
KRISTI SHAW
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Hampton Manor Of Ormond Beach Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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Other Providers at the Same Location


The following 6 providers are registered at the same or a nearby location.

Assisted Living Facility
1050 OCEAN SHORE BLVD
ORMOND BEACH, FL 32176
Assisted Living Facility
1050 OCEAN SHORE BLVD
ORMOND BEACH, FL 32176
Assisted Living Facility
1050 OCEAN SHORE BLVD
ORMOND BEACH, FL 32176
Physical Therapist
1050 OCEAN SHORE BLVD
ORMOND BEACH, FL 32176
Occupational Therapist
1050 OCEAN SHORE BLVD
ORMOND BEACH, FL 32176
Occupational Therapy Assistant
1050 OCEAN SHORE BLVD
ORMOND BEACH, FL 32176

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1184944472, enumerated as an "organization" on June 09, 2010.

The provider is located at 1050 OCEAN SHORE BLVD ORMOND BEACH, FL 32176 and the phone number is (386) 441-1771.

Assisted Living Facility with taxonomy code 310400000X.