=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669724977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALMOST HOME MANAGEMENT FOUNDATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2012
-----------------------------------------------------
Last Update Date | 10/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 W 1ST ST
-----------------------------------------------------
City | ATLANTIC BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32233-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-249-3233
-----------------------------------------------------
Fax | 904-249-3237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9664 HOOD RD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32257-1141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-249-3233
-----------------------------------------------------
Fax | 904-249-3237
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMIE LOUISE GLAVICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-610-6602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL9590
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------