Healthcare Provider Details

I. General information

NPI: 1154815157
Provider Name (Legal Business Name): JAC HOME HEALTH AGENCY & DME CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17360 S DIXIE HWY
PALMETTO BAY FL
33157-4319
US

IV. Provider business mailing address

17360 S DIXIE HWY
PALMETTO BAY FL
33157-4319
US

V. Phone/Fax

Practice location:
  • Phone: 786-269-5612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ADRIA CESPEDES
Title or Position: OWNER
Credential:
Phone: 786-269-5612