Healthcare Provider Details

I. General information

NPI: 1023370509
Provider Name (Legal Business Name): CHINASA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 LAGUNA CT ABUNDANT HOMEMAKERS
ST AUGUSTINE FL
32086-7033
US

IV. Provider business mailing address

194 LAGUNA CT ABUNDANT HOMEMAKERS
ST AUGUSTINE FL
32086-7033
US

V. Phone/Fax

Practice location:
  • Phone: 904-473-7603
  • Fax:
Mailing address:
  • Phone: 904-473-7603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number232575
License Number StateFL

VIII. Authorized Official

Name: MS. CRYSTAL EVANS
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-473-7603