Healthcare Provider Details

I. General information

NPI: 1124628565
Provider Name (Legal Business Name): RACHELLE HOMEHEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8539 GATE PKWY W UNIT 9134
JACKSONVILLE FL
32216-1037
US

IV. Provider business mailing address

8539 GATE PKWY W UNIT 9134
JACKSONVILLE FL
32216-1037
US

V. Phone/Fax

Practice location:
  • Phone: 904-415-0913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RACHELLE WILLIAMS
Title or Position: REGISTER NURSE
Credential:
Phone: 904-415-0913