Healthcare Provider Details

I. General information

NPI: 1780160192
Provider Name (Legal Business Name): GANESH HEALTHCARE OF JAX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 CESERY BLVD STE 150
JACKSONVILLE FL
32211
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:
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 State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. VIPUL R PATEL
Title or Position: CEO
Credential: DC
Phone: 904-487-8320