MEDICARE: NORTHEAST FLORIDA RESIDENTIAL CARE FACILITY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	177F00000X	Lodging Provider
3	251G00000X	Community Based Hospice Care Agency
4	385H00000X	Respite Care
5	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
6	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1982460747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST FLORIDA RESIDENTIAL CARE FACILITY INC

Provider Business Mailing Address
First Line	:	4232 ARBOR MILL CIR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-3204
Country	:	US
Telephone Number	:	904-532-5186
Fax Number	:

Provider Business Practice Location Address
First Line	:	4232 ARBOR MILL CIR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-3204
Country	:	US
Telephone Number	:	904-532-5186
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LEAUNDRIA DENISE SHAHEED
Credential	:
Telephone Number	:	904-532-5186

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	02/27/2024

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