Healthcare Provider Details

I. General information

NPI: 1356166847
Provider Name (Legal Business Name): GRAHAMS PROMISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7563 PHILIPS HWY STE 303
JACKSONVILLE FL
32256-6858
US

IV. Provider business mailing address

13009 LOBLOLLY LN S
JACKSONVILLE FL
32246-1073
US

V. Phone/Fax

Practice location:
  • Phone: 904-859-8270
  • Fax:
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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH MARIE GRAHAM
Title or Position: OWNER
Credential:
Phone: 904-859-8270