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General NPI Number Information
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NPI Number | 1528347630
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Entity Type | Organization
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Legal Business Name | GREATERJAXHOMEHEALTHSERVICESLLC
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Dates
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Enumeration Date | 08/06/2011
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Last Update Date | 08/06/2011
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Provider Practice Location Address
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Address Line | 7749 NORMANDY BLVD # 145-338
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City | JACKSONVILLE
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State | FL
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Zip | 32221-7657
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Country | US
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Telephone | 904-647-5063
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Fax | 904-647-6134
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Provider Business Mailing Address
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Address Line | 7749 NORMANDY BLVD # 145-338
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City | JACKSONVILLE
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State | FL
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Zip | 32221-7657
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Country | US
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Telephone | 904-647-5063
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Fax | 904-647-6134
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | EDNA WATKINS
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Credential |
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Telephone | 904-647-5063
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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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