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General NPI Number Information
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NPI Number | 1528481108
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Entity Type | Organization
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Legal Business Name | PORTER'S ADULT CARE INC,
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Dates
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Enumeration Date | 02/02/2014
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 700 DAY AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32205-5504
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Country | US
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Telephone | 904-349-1420
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Fax |
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Provider Business Mailing Address
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Address Line | 700 DAY AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32205-5504
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Country | US
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Telephone | 904-349-1420
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LASHANA MEDINA PORTER
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Credential |
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Telephone | 904-930-7579
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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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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12235
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License Number State | FL
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