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General NPI Number Information
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NPI Number | 1851711279
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Entity Type | Organization
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Legal Business Name | SHIPP ADULT FAMILY CARE HOME
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Dates
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Enumeration Date | 04/24/2014
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 8942 6TH AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32208-2126
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Country | US
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Telephone | 904-766-1850
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Fax | 904-766-1850
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Provider Business Mailing Address
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Address Line | 8942 6TH AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32208-2126
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Country | US
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Telephone | 904-766-1850
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. DELOIS W SHIPP
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Credential |
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Telephone | 904-766-1850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | AF33
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License Number State | FL
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