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General NPI Number Information
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NPI Number | 1003299603
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Entity Type | Organization
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Legal Business Name | UPSCALE PERSONAL CARE HOME
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 4375 AUTUMN RIVER ROAD
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City | JACKSONVILLE
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State | FL
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Zip | 32224
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Country | US
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Telephone | 904-762-5477
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Fax | 904-239-3088
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Provider Business Mailing Address
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Address Line | PO BOX 40673
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City | JACKSONVILLE
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State | FL
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Zip | 32203-0673
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Country | US
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Telephone | 904-762-5477
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Fax | 904-239-3088
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. REGINA HENDERSON
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Credential |
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Telephone | 404-693-3033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12575
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License Number State | FL
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