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General NPI Number Information
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NPI Number | 1760335582
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Entity Type | Organization
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Legal Business Name | A FULLER LIFESTYLE GROUP HOME INC
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Dates
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Enumeration Date | 02/19/2026
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 8567 CHERYL ANN LN
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City | JACKSONVILLE
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State | FL
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Zip | 32244-1272
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Country | US
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Telephone | 904-894-9979
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Fax | 904-894-9979
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Provider Business Mailing Address
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Address Line | 4349 BOAT CLUB DR
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City | JACKSONVILLE
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State | FL
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Zip | 32277-1202
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Country | US
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Telephone | 904-894-9979
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Fax | 904-894-9979
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORENZO JAMES FULLER
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Credential |
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Telephone | 904-894-9979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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