Healthcare Provider Details

I. General information

NPI: 1508917071
Provider Name (Legal Business Name): BETTER CARE OF JAX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2658 SANDRA LN
JACKSONVILLE FL
32208-2570
US

IV. Provider business mailing address

2658 SANDRA LN
JACKSONVILLE FL
32208-2570
US

V. Phone/Fax

Practice location:
  • Phone: 904-472-0066
  • Fax:
Mailing address:
  • Phone: 904-472-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number691047596
License Number StateFL

VIII. Authorized Official

Name: MS. LAQUITA SHANELLE BUCKHOLTZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-472-0066