Healthcare Provider Details

I. General information

NPI: 1902729494
Provider Name (Legal Business Name): WHOLEPATH COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 MONCRIEF RD STE 200
JACKSONVILLE FL
32209-4340
US

IV. Provider business mailing address

10948 RIVER FALLS DR
JACKSONVILLE FL
32219-5137
US

V. Phone/Fax

Practice location:
  • Phone: 904-659-7643
  • Fax:
Mailing address:
  • Phone: 904-659-7643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: NIA BEYAH
Title or Position: CEO
Credential:
Phone: 904-254-0400