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General NPI Number Information
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NPI Number | 1700226552
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Entity Type | Organization
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Legal Business Name | SOME PLACE LIKE HOME, INC
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | 1499 BASSETT RD
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City | JACKSONVILLE
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State | FL
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Zip | 32208-1559
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Country | US
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Telephone | 904-766-8320
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Fax |
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Provider Business Mailing Address
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Address Line | 3930 NOVALINE LN
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City | JACKSONVILLE
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State | FL
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Zip | 32277-2247
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Country | US
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Telephone | 904-744-8580
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BARBARA Y TIDWELL
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Credential |
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Telephone | 904-744-8580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12072
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License Number State | FL
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