Healthcare Provider Details

I. General information

NPI: 1245747930
Provider Name (Legal Business Name): LIFE'S ESSENCE ADULT DAY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 ARLINGTON RD N
JACKSONVILLE FL
32211-5811
US

IV. Provider business mailing address

1068 ARLINGTON RD N
JACKSONVILLE FL
32211-5811
US

V. Phone/Fax

Practice location:
  • Phone: 904-503-2244
  • Fax: 904-503-2284
Mailing address:
  • Phone: 904-503-2244
  • Fax: 904-503-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9382
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number9382
License Number StateFL

VIII. Authorized Official

Name: MRS. BERCLINE DORCELUS
Title or Position: CENTER DIRECTOR
Credential: RN
Phone: 904-503-2244