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General NPI Number Information
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NPI Number | 1487860441
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Entity Type | Organization
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Legal Business Name | QUALITY CARE SUPPORT SERVICES 51, INC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2121 CORPORATE SQUARE BLVD SUITE 120
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City | JACKSONVILLE
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State | FL
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Zip | 32216-0309
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Country | US
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Telephone | 904-725-2367
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Fax | 904-725-2364
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Provider Business Mailing Address
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Address Line | 2121 CORPORATE SQUARE BLVD SUITE 120
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City | JACKSONVILLE
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State | FL
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Zip | 32216-0309
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Country | US
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Telephone | 904-725-2367
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Fax | 904-725-2364
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GAIL H CLARK-JINKS
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Credential |
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Telephone | 904-725-2367
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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 | MC772.325-4
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License Number State | FL
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