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General NPI Number Information
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NPI Number | 1295429918
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Entity Type | Organization
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Legal Business Name | A PREMIER LIVING CARE CENTER LLC
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 5204 BRUNCHE DRIVE
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City | JACKSONVILLE
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State | FL
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Zip | 32209
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Country | US
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Telephone | 904-485-0978
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Fax |
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Provider Business Mailing Address
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Address Line | 4720 SALISBURY RD
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DEBRA AVERY
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Credential |
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Telephone | 904-485-0978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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