Healthcare Provider Details

I. General information

NPI: 1922451699
Provider Name (Legal Business Name): GARCIA REEVES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 09/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6251 PHILIPS HIGHWAY SUITE 4
JACKSONVILLE FL
32216
US

IV. Provider business mailing address

6251 PHILIPS HWY SUITE 4
JACKSONVILLE FL
32216-0990
US

V. Phone/Fax

Practice location:
  • Phone: 904-321-9190
  • Fax: 904-634-7225
Mailing address:
  • Phone: 904-321-9190
  • Fax: 904-634-7225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number233292
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number233292
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number233292
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number233292
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number2081P0301X
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number233292
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number233292
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number233292
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number233292
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number233292
License Number StateFL
# 11
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: JESSICA IRENE RAMOS
Title or Position: AGENCY ADMINSTRATOR
Credential:
Phone: 904-321-9190