Healthcare Provider Details

I. General information

NPI: 1326542929
Provider Name (Legal Business Name): GANESH BUSINESS GROUP, LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 CESERY BLVD STE 106
JACKSONVILLE FL
32211-7165
US

IV. Provider business mailing address

644 CESERY BLVD STE 106
JACKSONVILLE FL
32211-7165
US

V. Phone/Fax

Practice location:
  • Phone: 904-420-3900
  • Fax: 904-420-3905
Mailing address:
  • Phone: 904-420-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: PATHIK SHAH
Title or Position: MANAGING MEMBER
Credential:
Phone: 904-279-0279