=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518309319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTHA'S ADULT DAYCARE & SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2013
-----------------------------------------------------
Last Update Date | 03/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1680 DUNN AVE. UNITS 23, 24, 25
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32218-4782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-766-0496
-----------------------------------------------------
Fax | 904-766-0497
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8668 LEM TURNER RD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32208-2667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-766-0496
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MARY MARTHA JONES-WALKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-766-0496
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 9249
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------