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General NPI Number Information
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NPI Number | 1457661910
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Entity Type | Organization
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Legal Business Name | PRINCENIA A HICKS HOMEMAKER COMPANION SERVICE
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 6028 CHESTER AVE SUITE # 203
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City | JACKSONVILLE
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State | FL
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Zip | 32217-1205
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Country | US
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Telephone | 904-638-9710
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Fax | 904-212-0197
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Provider Business Mailing Address
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Address Line | 6028 CHESTER AVE SUITE # 203
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City | JACKSONVILLE
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State | FL
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Zip | 32217-1205
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Country | US
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Telephone | 904-638-9710
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Fax | 904-212-0197
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PRINCENIA HICKS MASON
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Credential |
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Telephone | 904-638-9710
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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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