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General NPI Number Information
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NPI Number | 1669083192
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Entity Type | Organization
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Legal Business Name | BASCA INC
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 352 STOWE AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-5547
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Country | US
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Telephone | 904-541-1742
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Fax | 904-278-6686
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Provider Business Mailing Address
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Address Line | 352 STOWE AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-5547
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Country | US
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Telephone | 904-541-1742
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Fax | 904-278-6686
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF PROGRAMS
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Name | PATRICE SHERMAN
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Credential |
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Telephone | 904-541-1742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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