Provider Profile
KINGS HOUSE II
Assisted Living Facility
FACILITY PROFILE
Street Address
- 8356 JUSTIN RD SOUTH
JACKSONVILLE, FL 32210
County: Duval - Phone: (904) 894-6828
Mailing Address
- 5108 ABEL LANE
JACKSONVILLE, FL 32210
County: Duval - Phone: (904) 894-6828
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Facility Information:
| Facility/Provider Type: | Assisted Living Facility |
| Administrator: | MELISSA WADE |
| Financial Officer: | MELISSA WADE |
| Owner/Licensee: | POWER HOUSE MIRACLE CENTER MINISTRY INC |
| Owner/Licensee Since: | 1/30/2014 |
| Profit Status: | Not-For-Profit |
| Management Company: | Not Available |
| Manager Since: | Not Available |
| Licensed Beds: | 5 |
| Bed Types: | Extended Congregate Care: 0 Total Capacity: 5 Private: 1 Optional State Supplement: 4 |
| AHCA Number (File Number): | 11968215 |
| AHCA Field Office: | 04 |
| License Number: | 12135 |
| Current License Effective: | 2/19/2024 |
| Current License Expires: | 2/2/2024 |
| License Status: | IN LITIGATION |
Services/Characteristics
| Medicaid Services: | Assistive Care Services |
| Activities: | Arts and CraftsGames/CardsGardeningShoppingSocial Events/Outings |
| 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: | Direct Part-Time |
| Payment Forms Accepted: | Insurance and/or HMOMedicaidMedicareVA |
| Religious Affiliations: | Christian (non-denominational) |
| Community Residential Home | Yes |
Please be advised that local zoning authorities may have additional restrictions or requirements not under the jurisdiction of the Agency for Health Care Administration. Contact your local zoning authorities for any specific requirements. See also 419.001 F.S.
Emergency Power Plan Summary
| Onsite Alternate Power Source: | Portable Generator |
| Emergency Power Supports: | OtherRefrigeration |
| Plan Approval: | 1/18/2018 |
| Implementation Date: | 1/18/2018 |
| Cooling Method: | Air Conditioner |
| Areas Cooled: | Common AreasLiving room |
| Areas Cooled Location: | Within Facility |
| Square Footage Cooled: | 800 |
| Number of People to use Cooled Space: | 6 |
Legal Actions
| Date Initiated | Case # | Case Type | Violation | Fine Amount | Date Imposed |
|---|---|---|---|---|---|
| 1/24/2024 | 2024001211 | Fine | Survey | $650.00 | 5/29/2024 |
| 8/1/2018 | 2018011457 | Fine | Licensure | $500.00 | 2/6/2019 |
| 3/19/2018 | 2018003905 | Fine | Application | $750.00 | 8/28/2018 |
| 3/1/2016 | 2016002164 | Conditional License | Application | $0.00 | 1/4/2018 |
| Change of ownership occurred 2/3/2014 | |||||
| 2/14/2013 | 2013001800 | Fine | Survey | $500.00 | 7/23/2013 |
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.