Healthcare Provider Details

I. General information

NPI: 1134996150
Provider Name (Legal Business Name): WELLNESS WINGS HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 06/21/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1967 HARDEE ST
JACKSONVILLE FL
32209-7157
US

IV. Provider business mailing address

11111 SAN JOSE BLVD STE 56
JACKSONVILLE FL
32223-7274
US

V. Phone/Fax

Practice location:
  • Phone: 904-521-4627
  • Fax:
Mailing address:
  • Phone: 904-521-4627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KEIA KASHAY HOUSTON
Title or Position: OWNER
Credential:
Phone: 904-521-4627