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General NPI Number Information
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NPI Number | 1285127688
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Entity Type | Organization
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Legal Business Name | NE FLORIDA ENTERPRISES, LLC
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 10175 FORTUNE PKWY UNIT 202
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6748
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Country | US
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Telephone | 904-201-3566
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Fax |
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Provider Business Mailing Address
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Address Line | 101 MARKETSIDE AVE # 404-168
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City | PONTE VEDRA
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State | FL
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Zip | 32081-1541
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Country | US
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Telephone | 904-201-3566
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Fax |
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Authorized Official
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Title or Position | OWNER AND OPERATING PRINCIPAL
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Name | KIMBERLEY SCHAFER
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Credential |
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Telephone | 904-201-3566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 234803
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 299994713
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License Number State | FL
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