Healthcare Provider Details

I. General information

NPI: 1972861185
Provider Name (Legal Business Name): HOPE ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 ROBERTS DRIVE
JACKSONVILLE FL
32250-3222
US

IV. Provider business mailing address

1560 ROBERTS DR
JACKSONVILLE FL
32250-3222
US

V. Phone/Fax

Practice location:
  • Phone: 904-249-4673
  • Fax: 904-249-4619
Mailing address:
  • Phone: 904-249-4673
  • Fax: 904-249-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number9035
License Number StateFL

VIII. Authorized Official

Name: MS. DEBRA JEAN JOHNSON
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 904-249-4673