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General NPI Number Information
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NPI Number | 1598160632
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Entity Type | Organization
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Legal Business Name | CHARLOTTE'S WAY ADC INC.
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Dates
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Enumeration Date | 10/31/2014
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Last Update Date | 10/31/2014
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Provider Practice Location Address
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Address Line | 2538 BLACKSTONE CT
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City | JACKSONVILLE
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State | FL
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Zip | 32221-4909
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Country | US
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Telephone | 904-365-7161
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Fax |
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Provider Business Mailing Address
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Address Line | 2538 BLACKSTONE CT
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City | JACKSONVILLE
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State | FL
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Zip | 32221-4909
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Country | US
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Telephone | 904-365-7161
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ERNESTINE APPLETON
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Credential |
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Telephone | 904-365-7161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 005627300
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License Number State | FL
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