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General NPI Number Information
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NPI Number | 1780160192
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Entity Type | Organization
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Legal Business Name | GANESH HEALTHCARE OF JAX LLC
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 644 CESERY BLVD STE 150
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City | JACKSONVILLE
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State | FL
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Zip | 32211
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Country | US
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Telephone | 904-420-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 644 CESERY BLVD STE 106
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City | JACKSONVILLE
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State | FL
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Zip | 32211-7165
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Country | US
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Telephone | 904-420-3900
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. VIPUL R PATEL
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Credential | DC
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Telephone | 904-487-8320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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