Healthcare Provider Details

I. General information

NPI: 1215345160
Provider Name (Legal Business Name): DESIRE HEALTH CARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 UNIVERSITY BLVD S STE A8
JACKSONVILLE FL
32216-4210
US

IV. Provider business mailing address

3636 UNIVERSITY BLVD S STE A8
JACKSONVILLE FL
32216-4210
US

V. Phone/Fax

Practice location:
  • Phone: 904-553-4900
  • Fax: 866-266-8160
Mailing address:
  • Phone: 904-553-4900
  • Fax: 866-266-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299994677
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GEYSEL ACOSTA
Title or Position: ADMINISTRATOR, CEO
Credential:
Phone: 904-504-0504