Healthcare Provider Details

I. General information

NPI: 1720819915
Provider Name (Legal Business Name): PEACHES-NA-BASKET ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 SOUTEL DR
JACKSONVILLE FL
32208-2280
US

IV. Provider business mailing address

2040 SOUTEL DR
JACKSONVILLE FL
32208-2280
US

V. Phone/Fax

Practice location:
  • Phone: 904-766-4993
  • Fax:
Mailing address:
  • Phone:
  • 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: BERTHA FLEMMING
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.A.
Phone: 904-766-4993