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General NPI Number Information
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NPI Number | 1225575095
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Entity Type | Organization
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Legal Business Name | HAGAN HOMEMAKER COMPANION SERVICE
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Dates
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Enumeration Date | 01/31/2017
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 6099 GULF RD N
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City | JACKSONVILLE
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State | FL
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Zip | 32244-2522
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Country | US
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Telephone | 904-545-8002
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Fax | 904-723-1829
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Provider Business Mailing Address
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Address Line | 6099 GULF RD N
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City | JACKSONVILLE
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State | FL
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Zip | 32244-2522
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Country | US
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Telephone | 904-545-8002
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Fax | 904-723-1829
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BESSIE ELIZABETH HAGAN
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Credential |
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Telephone | 904-545-8002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 234002
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License Number State | FL
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