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General NPI Number Information
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NPI Number | 1508239047
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Entity Type | Organization
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Legal Business Name | A HOME SWEET HOME ALF OF JAX, INC.
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 6838 MEDELLIN CT
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City | JACKSONVILLE
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State | FL
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Zip | 32210-4922
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Country | US
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Telephone | 904-772-0651
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Fax | 904-438-5726
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Provider Business Mailing Address
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Address Line | 6838 MEDELLIN CT
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City | JACKSONVILLE
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State | FL
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Zip | 32210-4922
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Country | US
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Telephone | 904-772-0651
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Fax | 904-438-5726
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MRS. LANISHA J HOLLOWAY
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Credential |
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Telephone | 904-772-0651
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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 |
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License Number State | FL
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