MEDICARE: EMMANUEL HOME CARE JAX 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1861347890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL HOME CARE JAX LLC

Provider Business Mailing Address
First Line	:	6535 BIG STONE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-6843
Country	:	US
Telephone Number	:	904-574-8199
Fax Number	:

Provider Business Practice Location Address
First Line	:	6535 BIG STONE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-6843
Country	:	US
Telephone Number	:	904-574-8199
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JEAN KITUA KALUME
Credential	:
Telephone Number	:	256-651-8311

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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