Healthcare Provider Details

I. General information

NPI: 1770256919
Provider Name (Legal Business Name): EENCORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2021
Last Update Date: 07/25/2021
Certification Date: 07/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 KINGSLEY AVE STE 6
ORANGE PARK FL
32073-4418
US

IV. Provider business mailing address

1734 KINGSLEY AVE STE 6
ORANGE PARK FL
32073-4418
US

V. Phone/Fax

Practice location:
  • Phone: 904-521-0493
  • Fax:
Mailing address:
  • Phone: 904-521-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: APRIL GIBSON
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 904-521-0493