Provider Profile
DIVERSITY ME
Assisted Living Facility
FACILITY PROFILE
Street Address
- 3225 N MYRTLE AVE
JACKSONVILLE, FL 32209
County: Duval - Phone: (904) 355-6819
Mailing Address
- 3225 N MYRTLE AVE
JACKSONVILLE, FL 32209
County: Duval - Phone: (904) 233-1090
Emergency Actions
| Legal Sanction | Status | Begin Date | End Date |
|---|---|---|---|
| Moratorium | Lifted | 10/16/2012 | 10/30/2012 |
AHCA Reports
Inspection ReportsInspection Details
Consumer Guides
Assisted Living in FloridaLong-Term Care
Patient Safety
Health Care Advance Directives
Facility Information:
| Facility/Provider Type: | Assisted Living Facility |
| Administrator: | TIKI STAFFORD |
| Financial Officer: | TIKI STAFFORD |
| Owner/Licensee: | TIKI STAFFORD |
| Owner/Licensee Since: | 12/7/2010 |
| Profit Status: | For-Profit |
| Management Company: | Not Available |
| Manager Since: | Not Available |
| Licensed Beds: | 16 |
| Bed Types: | Extended Congregate Care: 0 Total Capacity: 16 Optional State Supplement: 13 Private: 3 |
| AHCA Number (File Number): | 11967998 |
| AHCA Field Office: | 04 |
| License Number: | 11951 |
| Current License Effective: | 5/3/2023 |
| Current License Expires: | 5/2/2025 |
| License Status: | IN REVIEW |
Services/Characteristics
| Medicaid Services: | Assistive Care Services |
| Specialty License: | Limited Mental Health |
| Activities: | Arts and CraftsCooking ClassesDancingExercise ClassesGames/CardsShoppingSocial Events/OutingsTheater and Movies |
| Bed Hold Policy: | Facility will hold beds during a temporary absence |
| Adult Day Care Services: | No |
| Continuing Care Retirement Community: | No |
| Languages Spoken: | English |
| Nurse Availability: | None |
| Payment Forms Accepted: | Insurance and/or HMOMedicaidMedicareOtherVA |
Emergency Power Plan Summary
| Onsite Alternate Power Source: | Portable Generator |
| Emergency Power Supports: | LightsOtherRefrigeration |
| Plan Approval: | 10/31/2017 |
| Implementation Date: | 5/18/2018 |
| Cooling Method: | Air ConditionerFans |
| Areas Cooled: | Common AreasDining RoomLiving roomResident Rooms |
| Areas Cooled Location: | Within Facility |
| Square Footage Cooled: | 600 |
| Number of People to use Cooled Space: | 17 |
Legal Actions
| Date Initiated | Case # | Case Type | Violation | Fine Amount | Date Imposed |
|---|---|---|---|---|---|
| 4/6/2023 | 2023005771 | Fine | Survey | $500.00 | 10/6/2023 |
| 3/15/2019 | 2019004449 | Fine | Survey | $500.00 | 6/2/2021 |
| 8/1/2014 | 2014007637 | Fine | Survey | $2,500.00 | 5/19/2015 |
| 1/9/2013 | 2013000440 | Fine | Survey | $1,500.00 | 4/17/2013 |
| 10/23/2012 | 2012011590 | Fine | Survey | $5,000.00 | 4/17/2013 |
Important information and facility/provider definitions can be found in the Glossary.
Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.