=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760783773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FELICIA MITCHELL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2010
-----------------------------------------------------
Last Update Date | 11/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4911 SEABOARD CT
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32210-7948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-482-7879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4911 SEABOARD CT
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32210-7948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-482-7879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. FELICIA DENESE MITCHELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-476-4171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------