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General NPI Number Information
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NPI Number | 1437778727
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Entity Type | Organization
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Legal Business Name | STACY'S UNLIMITED SUPPORT SERVICES
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 7082 SAINT IVES CT
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City | JACKSONVILLE
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State | FL
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Zip | 32244-0300
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Country | US
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Telephone | 904-306-6623
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Fax |
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Provider Business Mailing Address
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Address Line | 7082 SAINT IVES CT
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City | JACKSONVILLE
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State | FL
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Zip | 32244-0300
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Country | US
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Telephone | 904-306-6623
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. STACY PATREACE GODWIN
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Credential | LPN WCC
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Telephone | 904-306-6623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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