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BROOKDALE ST. AUGUSTINE
NPI 1902132749
Assisted Living Facility in St Augustine, FL

Active since October 29, 2009CLIA 10D1080868 · Waiver
150 MARINER HEALTH WAY, ST AUGUSTINE, FL 32086(904) 794-9988 Get Directions Write a Review

NPPES record last updated: September 30, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 30, 2024, May 13, 2016 (2 updates tracked since 2016).

About Brookdale St. Augustine NPPES

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

BROOKDALE ST. AUGUSTINE (NPI 1902132749) is a healthcare organization registered as an assisted living facility in St Augustine, Florida and active in the NPI registry since October 2009. The organization holds a CLIA Waiver certificate valid through March 3, 2028 and lists Anna Munoz, Assistant Secretary, as its authorized official.

NPPES Registry Identity

NPI1902132749
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSUMMERVILLE AT ST. AUGUSTINE, LLC
Location Address150 MARINER HEALTH WAYSt Augustine, FL 32086-3215
Mailing Address150 Mariner Health WaySt Augustine, FL 32086-3215 · (904) 794-9988
Phone(904) 794-9988
Organization SubpartNo
Authorized OfficialAnna MunozAssistant Secretary · (414) 918-5443
Enumeration DateOctober 29, 2009
Last NPPES UpdateSeptember 30, 20242 updates tracked since enumeration
NPPES CertifiedSeptember 30, 2024
✔ NPI 1902132749 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 · AL9908
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.
150 MARINER HEALTH WAY, St Augustine, FL 32086
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Other Names 1

Doing Business AsBrookdale St. Augustine

Other Identifiers 1

Medicaid0124330-00FL

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 10D1080868

Brookdale St Augustine · Saint Augustine, FL
Active · expires Mar 3, 2028
CLIA Number10D1080868
Laboratory TypeAssisted Living Facility
Certificate Effective DateMarch 4, 2026
Certificate Expiration DateMarch 3, 2028
Laboratory DirectorChad Ansinson
Laboratory Phone(904) 794-9988
Laboratory LocationBrookdale St Augustine150 Mariner Health Way, Saint Augustine, FL 32086
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 14

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

ASHLEY GROUT HENNESSEE
Physical Therapy Assistant
150 MARINER HEALTH WAY
SAINT AUGUSTINE, FL 32086
St. Johns County (904) 584-1827
MARGARET E. BLISS MOTR/L
Occupational Therapist
150 MARINER HEALTH WAY
ST AUGUSTINE, FL 32086
St. Johns County (904) 794-9988
CHRISTINE MELISSA THORPE OT
Occupational Therapist
150 MARINER HEALTH WAY
ST AUGUSTINE, FL 32086
St. Johns County (904) 794-9988
MELINDA J HUG
Occupational Therapy Assistant
150 MARINER HEALTH WAY
ST AUGUSTINE, FL 32086
St. Johns County (855) 446-1603
SANDI AYMOND
Physical Therapy Assistant
150 MARINER HEALTH WAY
SAINT AUGUSTINE, FL 32086
St. Johns County (904) 794-9988
ERIN E CONRAD PT
Physical Therapist
150 MARINER HEALTH WAY
ST AUGUSTINE, FL 32086
St. Johns County (610) 991-2034
HOPE A. BELL PTA
Physical Therapy Assistant
150 MARINER HEALTH WAY
ST AUGUSTINE, FL 32086
St. Johns County (904) 797-8717
ANDREW KAWAMLEH
Physical Therapy Assistant
150 MARINER HEALTH WAY
ST AUGUSTINE, FL 32086
St. Johns County (904) 794-9988

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 St. Augustine, LLC's NPI number?

The NPI number for Summerville At St. Augustine, LLC is 1902132749. It was assigned to this organization in the NPPES registry on October 29, 2009. The provider is doing business as Brookdale St. Augustine.

Where is Summerville At St. Augustine, LLC located?

Summerville At St. Augustine, LLC is located at 150 Mariner Health Way, St Augustine, FL 32086. The listed phone number is (904) 794-9988.

What is Summerville At St. Augustine, LLC's specialty?

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

Does Summerville At St. Augustine, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D1080868) is associated with this NPI, valid through March 3, 2028. 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 St. Augustine, LLC was last updated on September 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months 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.