Healthcare Provider Details

I. General information

NPI: 1427350784
Provider Name (Legal Business Name): SIGNATURE SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STATE ROAD 13 STE 106 #236
SAINT JOHNS FL
32259-3863
US

IV. Provider business mailing address

450 STATE ROAD 13 STE 106 #236
SAINT JOHNS FL
32259-3863
US

V. Phone/Fax

Practice location:
  • Phone: 904-647-8088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT DUNCAN
Title or Position: OWNER
Credential:
Phone: 904-647-8088