=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760803373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARIAN LAVONNE JONES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2013
-----------------------------------------------------
Last Update Date | 10/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3501 CENTERHILL DR. NORTH
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-683-8096
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3501 CENTERHILL DR. NORTH
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-683-8096
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | MS. MARIAN LAVONNE JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-683-8096
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | 6906429
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------