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General NPI Number Information
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NPI Number | 1114737178
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Entity Type | Organization
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Legal Business Name | ELLIS-MOORE COROPORATION
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Dates
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Enumeration Date | 01/11/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 7207 GOLDEN WINGS RD STE 300
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City | JACKSONVILLE
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State | FL
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Zip | 32244-3324
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Country | US
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Telephone | 904-710-0437
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Fax | 904-475-2706
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Provider Business Mailing Address
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Address Line | 3901 UNIVERSITY BLVD S STE 125
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4375
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Country | US
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Telephone | 904-683-4355
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Fax | 904-683-7089
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. JONI HUGHES
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Credential | RN
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Telephone | 904-710-0437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number |
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License Number State |
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