Healthcare Provider Details

I. General information

NPI: 1518273895
Provider Name (Legal Business Name): AFFECTIONATE CARE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7846 STEPHENSON DR
JACKSONVILLE FL
32208-2748
US

IV. Provider business mailing address

7846 STEPHENSON DR
JACKSONVILLE FL
32208-2748
US

V. Phone/Fax

Practice location:
  • Phone: 904-365-9543
  • Fax:
Mailing address:
  • Phone: 904-365-9543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number693015896
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number693015898
License Number StateFL

VIII. Authorized Official

Name: MR. ARTHER LEE WILLIAMSON
Title or Position: PRESIDENT & CEO
Credential:
Phone: 904-365-9543