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General NPI Number Information
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NPI Number | 1104332188
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Entity Type | Organization
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Legal Business Name | REFFINES HOUSE
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 12/28/2017
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Provider Practice Location Address
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Address Line | 523 FERN ST
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City | JACKSONVILLE
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State | FL
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Zip | 32206-6238
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Country | US
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Telephone | 904-379-2061
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Fax |
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Provider Business Mailing Address
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Address Line | 523 FERN ST
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City | JACKSONVILLE
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State | FL
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Zip | 32206-6238
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Country | US
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Telephone | 904-379-2061
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Fax |
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Authorized Official
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Title or Position | ADMINISTARTOR
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Name | TIKI STAFFORD
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Credential |
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Telephone | 904-233-1090
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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 | AL11189
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License Number State |
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