Healthcare Provider Details

I. General information

NPI: 1629182142
Provider Name (Legal Business Name): JEFFERSON SENIOR CITIZEN'S CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 N JEFFERSON ST
MONTICELLO FL
32344-2246
US

IV. Provider business mailing address

1155 N JEFFERSON ST
MONTICELLO FL
32344-2246
US

V. Phone/Fax

Practice location:
  • Phone: 850-342-0242
  • Fax: 850-342-0630
Mailing address:
  • Phone: 850-342-0242
  • Fax: 850-342-0630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number5986
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MAZIE GLENN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 850-342-0242