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General NPI Number Information
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NPI Number | 1629896584
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Entity Type | Organization
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Legal Business Name | ADVANCE JACKSON HOME HEALTH SERVICES
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 6175 NW 153RD ST STE 223
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2420
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Country | US
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Telephone | 786-351-6114
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Fax |
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Provider Business Mailing Address
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Address Line | 6175 NW 153RD ST STE 223
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2420
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Country | US
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Telephone | 786-351-6114
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | MARLYN MOREJON
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Credential | APRN
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Telephone | 786-351-6114
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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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