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General NPI Number Information
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NPI Number | 1750875977
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Entity Type | Organization
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Legal Business Name | FUTURE SIXCESS ASSISTED LIVING FACILITY, LLC
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 11036 LYDIA ESTATES DR W
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City | JACKSONVILLE
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State | FL
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Zip | 32218-6937
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Country | US
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Telephone | 904-305-1608
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Fax |
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Provider Business Mailing Address
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Address Line | 11036 LYDIA ESTATES DR W
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City | JACKSONVILLE
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State | FL
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Zip | 32218-6937
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Country | US
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Telephone | 904-305-1608
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LACENDIA MITCHELL
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Credential |
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Telephone | 904-305-1608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State | FL
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