Healthcare Provider Details

I. General information

NPI: 1902066160
Provider Name (Legal Business Name): URBAN JACKSONVILLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 LAKESIDE DR STE 116
JACKSONVILLE FL
32210-3300
US

IV. Provider business mailing address

4250 LAKESIDE DR STE 116
JACKSONVILLE FL
32210-3300
US

V. Phone/Fax

Practice location:
  • Phone: 904-807-1203
  • Fax: 904-807-1220
Mailing address:
  • Phone: 904-807-1203
  • Fax: 904-807-1220

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 Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: TERESA BARTON
Title or Position: CEO
Credential:
Phone: 904-807-1240