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General NPI Number Information
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NPI Number | 1740851435
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Entity Type | Organization
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Legal Business Name | SHEANAS CARE SUPPORT LLC
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Dates
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Enumeration Date | 07/05/2021
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 6717 SOUTHERN OAKS DR
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City | JACKSONVILLE
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State | FL
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Zip | 32244-3675
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Country | US
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Telephone | 833-217-9523
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Fax | 904-799-6564
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Provider Business Mailing Address
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Address Line | 476 RIVERSIDE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32202-4912
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Country | US
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Telephone | 833-217-9523
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Fax | 904-799-6564
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Authorized Official
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Title or Position | OWNER
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Name | TYSHEANA M PETERSON
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Credential |
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Telephone | 904-899-2288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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