Healthcare Provider Details

I. General information

NPI: 1003899550
Provider Name (Legal Business Name): INTERIM HHA OF ST AUGUSTINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 US 1 S BUILDING 400, SUITE 404
ST AUGUSTINE FL
32086-6363
US

IV. Provider business mailing address

7400 BAYMEADOWS WAY STE 107
JACKSONVILLE FL
32256-6829
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-6123
  • Fax: 904-829-0999
Mailing address:
  • Phone: 904-448-1133
  • Fax: 904-448-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA20589096
License Number StateFL

VIII. Authorized Official

Name: STEVEN JAMES ALESSANDRO
Title or Position: CEO
Credential:
Phone: 847-457-1808