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NPI Code Detail

MEDICARE: 5TH ESSENTIALS LLC

MEDICARE: 5TH ESSENTIALS 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
1171400000XHealth & Wellness Coach
2251C00000XDevelopmentally Disabled Services Day Training Agency
3253Z00000XIn Home Supportive Care Agency
4310400000XAssisted Living Facility
5311ZA0620XAdult Care Home Facility
6343900000XNon-emergency Medical Transport (VAN)
7347C00000XPrivate Vehicle
8372500000XChore Provider
9374U00000XHome Health Aide
10225700000XMassage Therapist

General Provider Information

NPI Number : 1114760246
Entity Type Code : Organization
Provider Name (Legal Business Name) : 5TH ESSENTIALS LLC
Provider Business Mailing Address
First Line : 5706 BLACKTHORN RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32244-2008
Country : US
Telephone Number : 904-385-3288
Fax Number :
Provider Business Practice Location Address
First Line : 5706 BLACKTHORN RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32244-2008
Country : US
Telephone Number : 904-385-3288
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MS. JOSIE JACKSON
Credential : LMT
Telephone Number : 210-999-0960
Provider Enumeration Date : 06/17/2024
Last Update Date : 07/24/2024

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32204-4443
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1235388869 — MS. ROSEMARIE JOYCE ALLEN AP
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2008 RIVERSIDE AVENUE , SUITE 300
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1447642293 — MRS. VALERIE BAHAM
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3755 CHEROKEE VILLA LN
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Practice Fax:

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