Healthcare Provider Details

I. General information

NPI: 1649791823
Provider Name (Legal Business Name): FLAGLER HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HEALTH PARK BLVD STE 110
SAINT AUGUSTINE FL
32086-5794
US

IV. Provider business mailing address

400 HEALTH PARK BLVD
SAINT AUGUSTINE FL
32086-5784
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-2501
  • Fax: 904-797-5774
Mailing address:
  • Phone: 904-819-4400
  • Fax: 904-819-4472

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: MR. JOSEPH S. GORDY
Title or Position: CEO
Credential:
Phone: 904-819-4400