=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568718906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIAT LUX VENTURES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2012
-----------------------------------------------------
Last Update Date | 10/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4711 HWY 17TH S SUITE B2
-----------------------------------------------------
City | ORANGE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32003-8233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-701-7660
-----------------------------------------------------
Fax | 904-701-7665
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4711 US HIGHWAY 17 STE B2
-----------------------------------------------------
City | FLEMING ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32003-8238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-701-7660
-----------------------------------------------------
Fax | 904-701-7665
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARLYNN C. BRUNO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-349-8272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------