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General NPI Number Information
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NPI Number | 1841797354
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Entity Type | Organization
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Legal Business Name | OBI'S ADULT FAMILY CARE LLC
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 3130 KINGSTON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32254-2524
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Country | US
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Telephone | 904-728-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 KINGSTON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32254-2524
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Country | US
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Telephone | 904-728-7474
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAKAELA OBI
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Credential |
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Telephone | 904-728-7474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6906906
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License Number State | FL
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