MEDICARE: KEEPSAFE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service	N11795	FL

General Provider Information

NPI Number	:	1104822923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEEPSAFE CENTER, INC.

Provider Business Mailing Address
First Line	:	5626 SOUTEL DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-3772
Country	:	US
Telephone Number	:	904-768-6456
Fax Number	:	904-765-0264

Provider Business Practice Location Address
First Line	:	5626 SOUTEL DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-3772
Country	:	US
Telephone Number	:	904-768-6456
Fax Number	:	904-765-0264

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. HERMONYONE W WALKER
Credential	:	MS
Telephone Number	:	904-768-6456

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	08/22/2020

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