Healthcare Provider Details

I. General information

NPI: 1669987293
Provider Name (Legal Business Name): OBI'S ADULT FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 KINGSTON ST
JACKSONVILLE FL
32254-2524
US

IV. Provider business mailing address

3130 KINGSTON ST
JACKSONVILLE FL
32254-2524
US

V. Phone/Fax

Practice location:
  • Phone: 904-728-7474
  • Fax:
Mailing address:
  • Phone: 904-728-7474
  • 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 Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6906906
License Number StateFL

VIII. Authorized Official

Name: MAKAELA OBI
Title or Position: OWNER
Credential:
Phone: 904-728-7474