=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215177860
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILVER OAK ENTERPRISES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2009
-----------------------------------------------------
Last Update Date | 02/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8850 GOODBY'S EXECUTIVE DRIVE SUTIE A
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-240-1100
-----------------------------------------------------
Fax | 904-212-0030
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8850 GOODBY'S EXECUTIVE DRIVE SUITE A
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-240-1100
-----------------------------------------------------
Fax | 904-212-0030
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. SELENA S TOWNSEND
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 904-240-1100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299993402
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------