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General NPI Number Information
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NPI Number | 1457626863
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Entity Type | Organization
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Legal Business Name | GRANNY NANNIES
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 9471 BAYMEADOWS RD SUITE 403
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7932
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Country | US
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Telephone | 904-731-2100
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Fax | 904-731-2177
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Provider Business Mailing Address
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Address Line | 9471 BAYMEADOWS ROAD SUITE 403
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7937
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Country | US
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Telephone | 904-731-2100
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Fax | 904-731-2177
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MR. JERRY LAMBERT
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Credential |
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Telephone | 904-731-2100
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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 | 30211078
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License Number State | FL
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