MEDICARE: BSRS JACKSONVILLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1023753738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BSRS JACKSONVILLE LLC

Provider Business Mailing Address
First Line	:	2021 ART MUSEUM DR STE 115
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2588
Country	:	US
Telephone Number	:	904-525-7236
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 ART MUSEUM DR STE 115
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2588
Country	:	US
Telephone Number	:	904-525-7236
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RITA SANDERS
Credential	:
Telephone Number	:	904-525-7236

Provider Enumeration Date	:	04/28/2022
Last Update Date	:	08/03/2023

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