Healthcare Provider Details

I. General information

NPI: 1255979639
Provider Name (Legal Business Name): ALLSTAR HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12724 GRAN BAY PKWY W STE 410
JACKSONVILLE FL
32258-9486
US

IV. Provider business mailing address

12724 GRAN BAY PKWY W STE 410
JACKSONVILLE FL
32258-9486
US

V. Phone/Fax

Practice location:
  • Phone: 904-688-5100
  • Fax: 904-212-1524
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health 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: AMOGELANG KEAKOPA
Title or Position: PRESIDENT
Credential:
Phone: 904-514-7533