MEDICARE: MOMMIE HANDS HEALTH CARE AGENCY

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1508704586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMMIE HANDS HEALTH CARE AGENCY

Provider Business Mailing Address
First Line	:	2849 PALMDALE ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-2934
Country	:	US
Telephone Number	:	678-923-5253
Fax Number	:

Provider Business Practice Location Address
First Line	:	2849 PALMDALE ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-2934
Country	:	US
Telephone Number	:	678-923-5253
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ OPERATOR
Name	:	PAULINE CLAYTON
Credential	:
Telephone Number	:	678-923-5253

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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