Healthcare Provider Details

I. General information

NPI: 1740583020
Provider Name (Legal Business Name): HOPE ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 ROBERTS DR
JACKSONVILLE BEACH FL
32250-3222
US

IV. Provider business mailing address

1560 ROBERTS DR
JACKSONVILLE BEACH FL
32250-3222
US

V. Phone/Fax

Practice location:
  • Phone: 904-249-4673
  • Fax: 904-249-4617
Mailing address:
  • Phone: 904-249-4673
  • Fax: 904-249-4617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9053
License Number StateFL

VIII. Authorized Official

Name: MR. WINSTON DANIELS
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-249-4673