MEDICARE: OAK AND IVY HOME CARE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251J00000X	Nursing Care Agency
3	253Z00000X	In Home Supportive Care Agency
4	372500000X	Chore Provider
5	374U00000X	Home Health Aide
6	376J00000X	Homemaker
7	376K00000X	Nurse's Aide
8	385H00000X	Respite Care
9	372600000X	Adult Companion
10	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1417749482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK AND IVY HOME CARE

Provider Business Mailing Address
First Line	:	193 BRADFORD LAKE CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-0103
Country	:	US
Telephone Number	:	904-697-8553
Fax Number	:

Provider Business Practice Location Address
First Line	:	193 BRADFORD LAKE CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-0103
Country	:	US
Telephone Number	:	904-697-8553
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. ANTHONY EUGENE FISHER
Credential	:	RN,MSN
Telephone Number	:	904-697-8553

Provider Enumeration Date	:	05/19/2025
Last Update Date	:	05/19/2025

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