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General NPI Number Information
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NPI Number | 1003858655
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Entity Type | Organization
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Legal Business Name | ENCOMPASS CARE COMPANY, INC.
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 4131 UNIVERSITY BLVD S STE 10
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4346
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Country | US
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Telephone | 508-769-2707
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Fax |
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Provider Business Mailing Address
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Address Line | 244 SILVER GLEN AVE
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-2470
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Country | US
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Telephone | 508-769-2707
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Fax | 508-203-4685
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. BORIS BERGUS
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Credential | M.D.
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Telephone | 508-769-2707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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