Healthcare Provider Details

I. General information

NPI: 1619718970
Provider Name (Legal Business Name): STAY FOR THE DAY ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 DUVAL STATION RD STE 107-265
JACKSONVILLE FL
32218-0800
US

IV. Provider business mailing address

731 DUVAL STATION RD STE 107-265
JACKSONVILLE FL
32218-0800
US

V. Phone/Fax

Practice location:
  • Phone: 904-502-6005
  • Fax:
Mailing address:
  • Phone: 904-502-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: QUINTON HALLIBURTON
Title or Position: OWNER
Credential:
Phone: 904-502-6005