Healthcare Provider Details

I. General information

NPI: 1871261867
Provider Name (Legal Business Name): SOLACE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 PEBBLE PATH LN
JACKSONVILLE FL
32224-1617
US

IV. Provider business mailing address

3551 PEBBLE PATH LN
JACKSONVILLE FL
32224-1617
US

V. Phone/Fax

Practice location:
  • Phone: 917-405-6992
  • Fax:
Mailing address:
  • Phone: 917-405-6992
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA GOMEZ SMITH
Title or Position: CEO
Credential:
Phone: 917-405-6992