=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194972315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMMD VENTURES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2008
-----------------------------------------------------
Last Update Date | 08/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4651 SALISBURY RD SUITE 452
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-6107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-838-6148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 464 SEBASTIAN SQ
-----------------------------------------------------
City | SAINT AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32095-6863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-826-3666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROSE RUSCITTO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-838-6148
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------