Healthcare Provider Details

I. General information

NPI: 1366178790
Provider Name (Legal Business Name): SURROUNDED BY LOVE SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9045 GLOUCESTERSHIRE CT
JACKSONVILLE FL
32219-4398
US

IV. Provider business mailing address

9045 GLOUCESTERSHIRE CT
JACKSONVILLE FL
32219-4398
US

V. Phone/Fax

Practice location:
  • Phone: 904-866-3717
  • Fax:
Mailing address:
  • Phone: 904-866-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: TAMEKA JONES
Title or Position: CEO
Credential:
Phone: 904-866-3717