Healthcare Provider Details

I. General information

NPI: 1710363965
Provider Name (Legal Business Name): FIFTH COMMANDMENT HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 KINGSLEY AVE SUITE 107
ORANGE PARK FL
32073-4603
US

IV. Provider business mailing address

1279 KINGSLEY AVE SUITE 107
ORANGE PARK FL
32073-4603
US

V. Phone/Fax

Practice location:
  • Phone: 904-592-7736
  • Fax: 904-602-5328
Mailing address:
  • Phone: 904-592-7736
  • Fax: 904-602-5328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BARBARA MARIE ENGELKES
Title or Position: OWNER/CEO/ADMINISTRATOR
Credential: NHA, CNA
Phone: 904-592-7736