Healthcare Provider Details

I. General information

NPI: 1376297242
Provider Name (Legal Business Name): CREDIBLE HOMECARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12627 SAN JOSE BLVD STE 504E
JACKSONVILLE FL
32223-8641
US

IV. Provider business mailing address

12627 SAN JOSE BLVD STE 504E
JACKSONVILLE FL
32223-8641
US

V. Phone/Fax

Practice location:
  • Phone: 904-523-4791
  • Fax: 904-297-2670
Mailing address:
  • Phone: 904-523-4791
  • Fax: 904-297-2670

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: ANTONINE ALEXIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-523-4791