Healthcare Provider Details

I. General information

NPI: 1609072644
Provider Name (Legal Business Name): JACKSON COUNTY SENIOR CITIZENS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 CLIFF ST
GRACEVILLE FL
32440-1732
US

IV. Provider business mailing address

5400 CLIFF ST
GRACEVILLE FL
32440-1732
US

V. Phone/Fax

Practice location:
  • Phone: 850-263-4650
  • Fax: 850-263-4136
Mailing address:
  • Phone: 850-263-4650
  • Fax: 850-263-4136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN D RHYNES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 850-263-4650