Healthcare Provider Details

I. General information

NPI: 1518309319
Provider Name (Legal Business Name): MARTHA'S ADULT DAYCARE & SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 DUNN AVE. UNITS 23, 24, 25
JACKSONVILLE FL
32218-4782
US

IV. Provider business mailing address

8668 LEM TURNER RD
JACKSONVILLE FL
32208-2667
US

V. Phone/Fax

Practice location:
  • Phone: 904-766-0496
  • Fax: 904-766-0497
Mailing address:
  • Phone: 904-766-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9249
License Number StateFL

VIII. Authorized Official

Name: MARY MARTHA JONES-WALKER
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 904-766-0496