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General NPI Number Information
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NPI Number | 1669319067
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Entity Type | Organization
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Legal Business Name | ILLUMINATE CHURCH OF THE SACRED JEWELS
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Dates
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Enumeration Date | 05/02/2026
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Last Update Date | 05/02/2026
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Provider Practice Location Address
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Address Line | 1339 CESERY TER # A
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City | JACKSONVILLE
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State | FL
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Zip | 32211-5324
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Country | US
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Telephone | 904-270-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 10700 BEACH BLVD UNIT 17465
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City | JACKSONVILLE
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State | FL
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Zip | 32245-8059
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Country | US
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Telephone | 904-270-9191
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Fax | 904-270-9191
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Authorized Official
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Title or Position | OVERSEER
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Name | GREGORY MCCALL
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Credential | MCCALL
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Telephone | 904-270-9191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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