Healthcare Provider Details

I. General information

NPI: 1891464160
Provider Name (Legal Business Name): CARE FOR THE BODY & SOUL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7772 US HIGHWAY 1 S UNIT A
ST AUGUSTINE FL
32086-7919
US

IV. Provider business mailing address

7772 US HIGHWAY 1 S UNIT A
ST AUGUSTINE FL
32086-7919
US

V. Phone/Fax

Practice location:
  • Phone: 352-275-9865
  • Fax: 904-615-9956
Mailing address:
  • Phone: 352-275-9865
  • Fax: 904-615-9956

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: JENNIFER LYNN DUTCHER
Title or Position: OWNER
Credential:
Phone: 352-275-9865