MEDICARE: FORGOTTEN HOPE LLC

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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1538773254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORGOTTEN HOPE LLC

Provider Business Mailing Address
First Line	:	5763 SAINT ISABEL DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1761
Country	:	US
Telephone Number	:	904-707-4175
Fax Number	:

Provider Business Practice Location Address
First Line	:	5763 SAINT ISABEL DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1761
Country	:	US
Telephone Number	:	904-707-4175
Fax Number	:

Authorized Official
Title or Position	:	RN
Name	:	MRS. ZENDRA LATURA HANSLEY
Credential	:	RN
Telephone Number	:	904-707-4175

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	09/01/2020

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Directions to “FORGOTTEN HOPE LLC ” Practice Location

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