Healthcare Provider Details

I. General information

NPI: 1710524806
Provider Name (Legal Business Name): ACCESSABLE AGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2019
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 JAYHAWK LN E
JACKSONVILLE FL
32221-8018
US

IV. Provider business mailing address

PO BOX 17391
JACKSONVILLE FL
32245-7391
US

V. Phone/Fax

Practice location:
  • Phone: 904-800-9874
  • Fax:
Mailing address:
  • Phone: 904-800-9874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code224ZL0004X
TaxonomyLow Vision Occupational Therapy Assistant
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code224ZR0403X
TaxonomyDriving and Community Mobility Occupational Therapy Assistant
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code224ZE0001X
TaxonomyEnvironmental Modification Occupational Therapy Assistant
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. AYESHA M HARRIS
Title or Position: OWNER
Credential:
Phone: 904-800-9874