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General NPI Number Information
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NPI Number | 1407291503
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Entity Type | Organization
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Legal Business Name | HOME SWEET HOME AT HOGAN LANE
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 1307 HOGAN LN
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City | JACKSONVILLE
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State | FL
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Zip | 32221-6616
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Country | US
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Telephone | 904-783-6473
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Fax | 904-783-6473
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Provider Business Mailing Address
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Address Line | 1307 HOGAN LN
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City | JACKSONVILLE
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State | FL
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Zip | 32221-6616
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Country | US
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Telephone | 904-783-6473
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Fax | 904-783-6473
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | JAMES THOMAS ROSE
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Credential |
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Telephone | 904-874-8182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 10443
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License Number State | FL
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