Healthcare Provider Details

I. General information

NPI: 1043653629
Provider Name (Legal Business Name): BELINDA RASHEED BONNER ADULT FAMILEY CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4223 HOMER RD S
JACKSONVILLE FL
32209-1613
US

IV. Provider business mailing address

4223 HOMER RD S
JACKSONVILLE FL
32209-1613
US

V. Phone/Fax

Practice location:
  • Phone: 904-236-7051
  • Fax:
Mailing address:
  • Phone: 904-236-7051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6906589
License Number StateFL

VIII. Authorized Official

Name: MRS. BELINDA RASHEED BONNER
Title or Position: CARE GIVER
Credential: PROVIDER
Phone: 904-236-7051