MEDICARE: PIC HOMES, INC.

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1306695754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIC HOMES, INC.

Provider Business Mailing Address
First Line	:	2161 COLLEGE CIR S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-5977
Country	:	US
Telephone Number	:	904-226-1817
Fax Number	:

Provider Business Practice Location Address
First Line	:	2161 COLLEGE CIR S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-5977
Country	:	US
Telephone Number	:	904-226-1817
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BRIAN PINCKNEY
Credential	:
Telephone Number	:	904-226-1817

Provider Enumeration Date	:	05/17/2024
Last Update Date	:	05/17/2024

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Directions to “PIC HOMES, INC. ” Practice Location

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