| Name: | Jacksonville Health and Rehabilitation, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 12 Jan 2000 (25 years ago) |
| Entity Number: | 000-668-052 |
| Register Number: | 000668052 |
| ZIP code: | 35203 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 420 NORTH 20TH ST STE 3100BIRMINGHAM, AL 35203 |
Activities
OPERATE/OWN SKILLED CARE NURSING FACILITIES
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| UBZZF53JM3K7 | 2024-07-31 | 410 WILSON DR SW, JACKSONVILLE, AL, 36265, 2754, USA | 410 WILSON DR SW, JACKSONVILLE, AL, 36265, USA | |||||||||||||||||||||||||||||||||||||||||||||
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| Division Name | JACKSONVILLE HEALTH AND REHABILITATION, LLC |
| Division Number | 43 |
| Congressional District | 03 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2023-08-09 |
| Initial Registration Date | 2016-04-06 |
| Entity Start Date | 2000-01-12 |
| Fiscal Year End Close Date | Dec 16 |
Service Classifications
| NAICS Codes | 623110 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | CASEY KNEPP |
| Role | FINANCIAL SPECIALIST |
| Address | 410 WILSON DRIVE SW, JACKSONVILLE, AL, 36265, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | CRAIG HILL |
| Role | ADMINISTRATOR |
| Address | 410 WILSON DRIVE SW, JACKSONVILLE, AL, 36265, USA |
| Past Performance | Information not Available |
|---|
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033166640 | 2006-05-28 | 2020-10-12 | 410 WILSON DR SW, JACKSONVILLE, AL, 362652754, US | 410 WILSON DR SW, JACKSONVILLE, AL, 362652754, US | |||||||||||||||||||||||||
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| Phone | +1 256-435-7704 |
Authorized person
| Name | PHILLIP CODY LONG |
| Role | CFO |
| Phone | 2053913600 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS ID |
| Number | 012231 |
| State | AL |
| Issuer | MEDICAID |
| Number | 4757820S |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CHRISTIAN, EDWARD R | Agent | 420 20TH ST N STE 3400BIRMINGHAM, AL 35203 |
| Name | Role |
|---|---|
| NORTHPORT HOLDING LLC | Member |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 345848196 | 0418300 | 2022-03-23 | 410 WILSON DR. SW, JACKSONVILLE, AL, 36265 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Type | Inspection |
| Activity Nr | 1488185 |
| Health | Yes |
| Inspection Type | Complaint |
| Scope | Partial |
| Safety/Health | Health |
| Close Conference | 2021-02-04 |
| Case Closed | 2021-10-25 |
Related Activity
| Type | Complaint |
| Activity Nr | 1637969 |
| Health | Yes |
Violation Items
| Citation ID | 01001A |
| Citaton Type | Other |
| Standard Cited | 19100134 E01 |
| Issuance Date | 2021-02-04 |
| Abatement Due Date | 2021-11-08 |
| Current Penalty | 13653.0 |
| Initial Penalty | 13653.0 |
| Contest Date | 2021-02-19 |
| Final Order | 2021-10-25 |
| Nr Instances | 1 |
| Nr Exposed | 58 |
| Gravity | 10 |
| FTA Current Penalty | 0.0 |
| Citation text line | 29 CFR 1910.134(e)(1):The employer did not provide a medical evaluation to determine the employee's ability to use a respirator, before the employee was fit tested or required to use the respirator in the workplace: a) Jacksonville Health and Rehabilitation, L.L.C. located at 410 Wilson Drive SW, Jacksonville, AL 36265: On or about 08/12/2020, the employer did not provide a medical evaluation to determine each employee's ability to use a respirator before requiring the use. The employer required employees to wear respirators while providing care to suspected and confirmed positive COVID-19 residents. |
| Citation ID | 01001B |
| Citaton Type | Serious |
| Standard Cited | 19100134 F02 |
| Issuance Date | 2021-02-04 |
| Abatement Due Date | 2021-03-03 |
| Current Penalty | 0.0 |
| Initial Penalty | 0.0 |
| Contest Date | 2021-02-19 |
| Final Order | 2021-10-25 |
| Nr Instances | 1 |
| Nr Exposed | 82 |
| Gravity | 10 |
| FTA Current Penalty | 0.0 |
| Citation text line | 29 CFR 1910.134(f)(2): Employee(s) using tight-fitting facepiece respirators were not fit tested prior to initial use of the respirator: a)Jacksonville Health and Rehabilitation, L.L.C. located at 410 Wilson Drive SW, Jacksonville, AL 36265: On or about 08/12/2020, the employer did not provide a fit test to all employees required to wear respirators. The employer required employees to wear N95 filtering facepiece respirators to protect against the SARS-CoV-2 virus while providing care to suspected and confirmed positive COVID-19 residents. |
| Inspection Type | Planned |
| Scope | Complete |
| Safety/Health | Health |
| Close Conference | 2008-01-08 |
| Emphasis | N: SSTARG07 |
| Case Closed | 2008-01-10 |
| Inspection Type | Planned |
| Scope | Complete |
| Safety/Health | Health |
| Close Conference | 2004-08-13 |
| Emphasis | N: NURSING, S: NURSING HOMES |
| Case Closed | 2007-04-05 |
Violation Items
| Citation ID | 01001 |
| Citaton Type | Serious |
| Standard Cited | 5A0001 |
| Issuance Date | 2004-08-16 |
| Abatement Due Date | 2006-01-31 |
| Current Penalty | 4500.0 |
| Initial Penalty | 4500.0 |
| Nr Instances | 1 |
| Nr Exposed | 100 |
| Gravity | 10 |
| Hazard | ERGONOMIC |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
