Healthcare Provider Details

I. General information

NPI: 1720900434
Provider Name (Legal Business Name): GEN224-TPL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR FL 12
JACKSONVILLE FL
32207-8874
US

IV. Provider business mailing address

PO BOX 440685
JACKSONVILLE FL
32222-0008
US

V. Phone/Fax

Practice location:
  • Phone: 833-569-0003
  • Fax: 850-427-7278
Mailing address:
  • Phone: 833-569-0003
  • Fax: 850-427-7278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ARLEN PIERRE LOUIS
Title or Position: MGR
Credential: CNA
Phone: 833-569-0003