Healthcare Provider Details

I. General information

NPI: 1427725837
Provider Name (Legal Business Name): ONE CALL AWAY HOME CARE & STAFFING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13720 OLD SAINT AUGUSTINE RD STE 8-236
JACKSONVILLE FL
32258-7414
US

IV. Provider business mailing address

13720 OLD SAINT AUGUSTINE RD STE 8-236
JACKSONVILLE FL
32258-7414
US

V. Phone/Fax

Practice location:
  • Phone: 866-974-6632
  • Fax:
Mailing address:
  • Phone: 866-974-6632
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LATASHA BURGESS
Title or Position: OWNER/ ADMINISTRATOR
Credential:
Phone: 866-974-6632